Intracranial Electrode Placement for Seizures Before Temporal Lobectomy: A Risk-Benefit Analysis.

BACKGROUND AND OBJECTIVE: Anterior temporal lobectomy (ATL) is the most common surgical procedure for refractory temporal lobe epilepsy. When scalp electroencephalography cannot adequately identify an epileptogenic site, electrode implantation may be used to monitor epileptic activity and localize a target focus before surgical resection. Whether the advantage of improved seizure localization justifies the added risk of electrode placement remains unclear. : The present study uses an international surgical database to explore whether a 2wo-stage approach, electrode implant followed by ATL, has a reasonable safety profile and is clinically worthwhile versus ATL alone. METHODS: Data from the American College of Surgeons National Surgical Quality Improvement Program for 2005 to 2016 were queried to identify patients undergoing ATL or electrode implant for epilepsy. The 30-day postoperative outcomes were analyzed for the electrode implant and ATL groups, and individual and combined risk profiles were determined. RESULTS: Patients undergoing electrode implant followed by ATL had a predicted reoperation rate of 7.6%, readmission rate of 14.6%, and a 30-day mortality rate of 1.2%. The combined rate of patients having ≥1 medical complication for 2-staged procedures was higher, at 14.7%. The most common complications encountered were urinary tract infection (2.7%) and sepsis (2.7%). CONCLUSIONS: Intracranial electrode placement increases the risk of complications when added to ATL. The severity of complications from electrode placement are mild, however, and as intracranial electrode recording provides a potentially large reduction in the surgical failure risk, electrode placement may be advisable for all but the most convincing seizure foci.

Acute Surgical Risk Profile of Intramedullary Spinal Cord Tumor Resection in Pediatric Patients: A Pediatric National Surgical Quality Improvement Program Analysis.

OBJECTIVE: The purpose of the present study was to characterize the acute (30-day) surgical risk profile of pediatric patients undergoing surgical resection of intramedullary spinal cord tumors (IMSCTs). METHODS: Preoperative factors were collected from the Pediatric American College of Surgeons National Surgical Quality Improvement Program database for patients identified by Current Procedural Terminology codes for laminectomy and International Classification of Diseases codes for IMSCTs from 2012 to 2016. The postoperative outcomes were compared by tumor location and type. RESULTS: The mean age of the 139 patients meeting all inclusion criteria was 8.7 years, with a male predominance (58.7%). The cervical and thoracic IMSCT populations had worst preoperative health status, as indicated by American Society of Anesthesiologists class, and a greater proportion of malignant tumors compared with the lumbar IMSCT population. No patient died; 8.6% of the patients were readmitted, and 6.5% required reoperation. Of the 12 readmissions, 8 were required for patients with malignant tumors. The patients with cervical IMSCTs returned to the operating room at a significantly greater rate than did the thoracic and lumbar IMSCT populations. Two common reasons for reoperation in the cervical population were issues related to respiration and hydrocephalus management. The complications included 13 cases of infection, 6 of urinary tract infection, and 5 cases of surgical site infection. CONCLUSIONS: Resection of IMSCTs in the pediatric population is a relatively low-risk procedure in terms of acute surgical complications. However, surgeons operating in the cervical spine should be aware of the increased risk of reoperation, in particular as it pertains to respiratory issues and hydrocephalus.