Is the use of Stereotactic Electroencephalography Safe and Effective in Children? A Meta-Analysis of the use of Stereotactic Electroencephalography in Comparison to Subdural Grids for Invasive Epilepsy Monitoring in Pediatric Subjects

Abstract

Background: Stereoelectroencephalography (SEEG) is an alternative addition to subdural grids (SDG) in invasive extra-operative monitoring for medically refractory epilepsy. Few studies exist on the clinical efficacy and safety of these techniques in pediatric populations.

Objective: To provide a comparative quantitative summary of surgical complications and postoperative seizure freedom associated with invasive extra-operative presurgical techniques in pediatric patients.

Methods: The systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A literature search was conducted utilizing Ovid Medline, Embase, Pubmed, and the Cochrane database.

Results: Fourteen papers with a total of 697 pediatric patients undergoing invasive SDG monitoring and 9 papers with a total of 277 pediatric patients undergoing SEEG monitoring were utilized in the systemic review. Cerebral spinal fluid (CSF) leaks were the most common adverse event in the SDG studies (pooled prevalence 11.9% 95% confidence interval [CI] 5.7-23.3). There was one case of CSF leak in the SEEG studies. Intracranial hemorrhages (SDG: 10.7%, 95% CI 5.3-20.3; SEEG: 2.9%, 95% CI -0.7 to 10.8) and infection (SDG: 10.8%, 95% CI 6.7-17) were more common in the SDG studies reviewed. At the time of the last postoperative visit, a greater percentage of pediatric patients achieved seizure freedom in the SEEG studies (SEEG: 66.5%, 95% CI 58.8-73.4; SDG: 52.1%, 95% CI 43.0-61.1).

Conclusion: SEEG is a safe alternative to SDG and should be considered on an individual basis for selected pediatric patients.

Keywords: Epilepsy; Invasive monitoring; Pediatric; SEEG.