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Complications of invasive video-EEG monitoring with subdural grid electrodes

From the Department of Neurology (Dr. Hamer), University of Marburg, Germany; and the Departments of Neurology (Drs. Morris, Bej, Burgess, Dinner, Foldvary, Kotagal, Najm, Wyllie, and Luders), Neurological Surgery (Drs. Bingaman and Hahn), and Biostatistics and Epidemiology (E. Mascha and M. Karafa), The Cleveland Clinic Foundation, OH.

Address correspondence and reprint requests to Dr. H.M. Hamer, Department of Neurology, University of Marburg, Rudolf-Bultmann-Str. 8, 35033 Marburg, Germany; e-mail: mer{at}mailer.uni-marburg.de

Objective: To evaluate the risk factors, type, and frequency of complications during video-EEG monitoring with subdural grid electrodes.

Methods: The authors retrospectively reviewed the records of all patients who underwent invasive monitoring with subdural grid electrodes (n = 198 monitoring sessions on 187 patients; median age: 24 years; range: 1 to 50 years) at the Cleveland Clinic Foundation from 1980 to 1997.

Results: From 1980 to 1997, the complication rate decreased (p = 0.003). In the last 5 years, 19/99 patients (19%) had complications, including two patients (2%) with permanent sequelae. In the last 3 years, the complication rate was 13.5% (n = 5/37) without permanent deficits. Overall, complications occurred during 52 monitoring sessions (26.3%): infection (n = 24; 12.1%), transient neurologic deficit (n = 22; 11.1%), epidural hematoma (n = 5; 2.5%), increased intracranial pressure (n = 5; 2.5%), and infarction (n = 3; 1.5%). One patient (0.5%) died during grid insertion. Complication occurrence was associated with greater number of grids/electrodes (p = 0.021/p = 0.052; especially >60 electrodes), longer duration of monitoring (p = 0.004; especially >10 days), older age of the patient (p = 0.005), left-sided grid insertion (p = 0.01), and burr holes in addition to the craniotomy (p = 0.022). No association with complications was found for number of seizures, IQ, anticonvulsants, or grid localization.

Conclusions: Invasive monitoring with grid electrodes was associated with significant complications. Most of them were transient. Increased complication rates were related to left-sided grid insertion and longer monitoring with a greater number of electrodes (especially more than 60 electrodes). Improvements in grid technology, surgical technique, and postoperative care resulted in significant reductions in the complication rate.

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