Long-Term Outcomes and Safety of Surgical Treatment Following Intracranial Electroencephalography Monitoring in
Takafumi Shimogawa1, Takato Morioka2, Kimiaki Hashiguchi3
1Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, JPN.
Insights
Pediatric intracranial electroencephalography (iEEG) monitoring and subsequent epilepsy surgery showed a 54.2% success rate with no major complications. Multimodal imaging, like MEG-MRI, may improve seizure outcomes in children.
Area of Science:
- Pediatric epilepsy surgery
- Neurophysiology
- Intracranial electroencephalography (iEEG)
Background:
- Pediatric intracranial electroencephalography (iEEG) monitoring presents unique challenges compared to adults.
- Long-term outcomes and complications of resective surgery post-iEEG in children are underreported.
Purpose of the Study:
- To evaluate the long-term outcomes and safety of surgical treatment following iEEG monitoring in pediatric patients.
- To assess the complication rate associated with iEEG implantation in children.
Main Methods:
- Retrospective analysis of 24 pediatric patients (≤15 years) undergoing surgery after iEEG implantation (1994-2024).
- Minimum 5-year follow-up, reviewing clinical data, iEEG details, surgical procedures, and seizure outcomes.
- Analysis included iEEG modalities (subdural grids, depth electrodes), surgical techniques (resection, lobectomy, MST), and imaging (MEG-MRI concordance).
Main Results:
- A 54.2% success rate (Engel class I or II outcomes) was achieved in pediatric patients undergoing epilepsy surgery post-iEEG.
- No perioperative complications related to iEEG implantation or permanent neurological deterioration occurred.
- Magnetoencephalography-magnetic resonance imaging (MEG-MRI) concordance was significantly associated with favorable seizure outcomes.
Conclusions:
- Epilepsy surgery following iEEG monitoring demonstrates good seizure outcomes and safety in pediatric patients.
- Careful planning, precise electrode placement, and vigilant perioperative management are crucial for safe iEEG in children.
- Multimodal imaging data, such as MEG-MRI concordance, may aid in personalized treatment planning for improved surgical outcomes.
Objective:
Intracranial electroencephalography (iEEG) monitoring presents additional challenges in pediatric patients compared to adults due to factors such as smaller body size, increased surgical invasiveness, difficulty maintaining rest, higher sensitivity to pain, and a greater risk of electrode self-removal. However, long-term outcomes and complications following resective surgery after iEEG evaluation in children remain underreported. This study aimed to evaluate the long-term outcomes and safety of surgical treatment following iEEG monitoring in pediatric patients.
Methods:
We retrospectively analyzed 24 pediatric patients (aged ≤15 years) who underwent surgical treatment after iEEG implantation between 1994 and 2024, with a minimum follow-up period of 5 years. Clinical characteristics, neuroimaging findings, details of iEEG monitoring, surgical procedures, epilepsy etiology, and seizure outcomes were reviewed.
Results:
The mean age at epilepsy onset was 4.5 years (range, 0.0-12.0), and the mean age at surgery was 10.4 years (range, 1.8-14.0). The average interval from seizure onset to surgery was 6.0 years (range, 0.9-14.8). The iEEG modalities included subdural grid electrodes alone (15 patients), a combination of subdural and depth electrodes (eight patients), and depth electrodes alone (one patient). The mean duration of iEEG monitoring was 9.1 days (range, 2-14). Surgical procedures included focal cortical resection and/or lesionectomy in 18 patients (75.0%), anterior temporal lobectomy in five (20.8%), and multiple subpial transections (MST) alone in one (4.2%). MST, in addition to resection, was performed in six patients (25.0%). Thirteen patients (54.2%) achieved Engel class I or II outcomes. No perioperative complications related to iEEG implantation occurred, and no patients experienced permanent neurological deterioration. Blood transfusion was not required in any case. MEG-MRI (magnetoencephalography-magnetic resonance imaging) concordance was significantly associated with favorable seizure outcomes.
Conclusion:
This study demonstrated a good seizure outcome rate of 54.2% in pediatric patients who underwent surgical treatment following iEEG monitoring. No major perioperative complications related to iEEG implantation were observed, and no patients experienced permanent neurological deterioration in this cohort. These findings suggest that with careful electrode selection, precise placement and fixation, and vigilant perioperative management, iEEG can be safely performed even in very young children. Furthermore, the presence of MEG clusters concordant with MRI lesions tended to be associated with better seizure outcomes after resection, suggesting a possible role of multimodal imaging data in individualized treatment planning.
