Anesthetic considerations for stereotactic electroencephalography implantation

Stereoelectroencephalography: a review of complications and outcomes in a new Australian centre

BACKGROUND

Surgical management of refractory focal epilepsy requires preoperative localisation of the epileptogenic zone (EZ). To augment noninvasive studies, stereoelectroencephalography (SEEG) is being increasingly adopted as a form of intracranial monitoring.

AIMS

This study aimed to determine the rate of complications for patients undergoing SEEG and to report the success of SEEG with regard to EZ detection and seizure outcome following definitive surgery.

METHODS

A retrospective cohort design investigated all cases of SEEG at our institution. Surgical, anaesthetic and medical complications with subsequent epilepsy surgery and seizure outcome data were extracted from medical records. Multivariate logistic regression was used to investigate the relationship between both the number of electrodes per patient and the duration of SEEG recording with the rate of complications.

RESULTS

Sixty-four patients with 66 implantations were included. Headache was the most common complication (n = 54, 82%). There were no major surgical or medical complications. Two anaesthetic complications occurred. EZ localisation was successful in 63 cases (95%). Curative intent surgery was performed in 39 patients (59%) and 23 patients achieved an Engel class I outcome (59% of those undergoing surgery). The number of electrodes and duration of recording were not associated with complications.

CONCLUSIONS

No patients in our series experienced major surgical or medical complications and we have highlighted the challenges associated with neuroanaesthesia in SEEG. Our complication rates and seizure outcomes are equivalent to published literature indicating that this technique can be successfully established in newer centres using careful case selection. Standardised reporting of SEEG complications should be adopted.

Perianaesthetic challenges in patients undergoing vagus nerve stimulation (VNS) placement

Patients with medically refractory epilepsy (MRE) are indicated for vagus nerve stimulation (VNS) placement. Anaesthesia for VNS placement is extremely challenging and requires several considerations. We present a man in his 20s with MRE who successfully underwent VNS placement. We review the mechanism of action of VNS, anaesthetic challenges and measures to prevent seizures.

Anesthetic Considerations for Functional Neurosurgery

Functional neurosurgery is a rapidly growing field that uses surgical resection, ablation, or neuromodulation to treat an assortment of neurologic and psychiatric disorders, the most common of which are movement disorders and epilepsy. Anesthesiologists caring for patients undergoing neurofunctional procedures should be aware of the anesthetic implications of patients' underlying disease as well as procedure-specific concerns, such as the effects of anesthetics on intraoperative neuromonitoring and limited access to patients due to stereotactic frames or intraoperative imaging.