Drill choice as a modifiable factor in pediatric sEEG safety

Stereoelectroencephalography (sEEG) procedures require drilling serial burr holes for electrode placement. Key drilling characteristics include haptic feedback, ease of use, and time-efficient burr hole creation. Orthopedic drill bits are often repurposed for sEEG. We present a case series highlighting sEEG as an application for a new-to-market neurosurgery-tailored drill.

We performed a retrospective chart review on patients who underwent sEEG at our institution from 2022-2023. Patients were grouped by type of drill, Phasor^® (a disposable battery-operated drill 3.20-mm diameter, 210-mm usable length) or Stryker^® (Orthopedic Drill Cordless).

Twelve patients underwent sEEG with the neurosurgery-tailored drill (2 unilateral and 10 bilateral); on average 10.7 ± 1.6 electrodes were placed per patient and mean operative duration was 162.9 ± 49 min. Tactile feel of bony layers and consistent drill time per burr hole (< 15 s) was subjectively noted. No complications were noted. Five patients underwent sEEG with the Stryker^® orthopedic drill (2 unilateral and 3 bilateral); an average of 11 ± 2.9 electrodes were placed per patient, mean operative duration was 176.4 ± 18.9 min. Subjectively, drill time per burr hole was variable and increased in duration between the first and final hole. One patient incurred a skin burn at the drill site which led to wound dehiscence and infection requiring prolonged wound care and antibiotics.

The Phasor^® drill offers a lightweight, reliable, consistent, safe and efficient option for sEEG burr hole creation and may be considered as an alternative to the Stryker^® orthopedic drill.