Post-Operative Outcomes and Rare Complications in Pediatric Stereotactic Electroencephalography: A Retrospective Review from a High Volume Pediatric Epilepsy Center

INTRODUCTION: Stereotactic electro-encephalography (sEEG) allows for spatial and temporal localization of epileptic foci for definitive treatment guidance. High volume center studies are more likely to detect rare, although potentially significant complications. METHODS: A retrospective review of 58 sEEG cases performed by a single surgeon at a single pediatric academic institution was performed. Patients <18 years old were included. Patients without 5 years of follow-up were excluded. RESULTS: 25 (49%) of the patients undergoing SEEG were non-lesional on pre-operative imaging. 50 patients (98%) received surgical treatment of their epilepsy following sEEG. 19 underwent open surgical resection of EZ, 16 laser interstitial thermal ablation, 13 responsive neurostimulation, and 1 was treated with DBS. We achieved Engle 1, 2, 3, and 4 level outcomes in 22 (55%), 8 (20%), 5(13%), 5 (13%) of patients respectively. Engle outcome scores were comparable for lesional and non-lesional EZ in patients who underwent resection (Engle 1 outcome in 10/12 and 1/2 respectively) and ablation (6/9 and 6/7, respectively). IPH occurred in 3 cases (5.2%), with only one requiring surgical evacuation. 2 of the 3 hemorrhages caused transient neurologic deficits and the third caused a longstanding hemiparesis. Two (3.4%) cases developed asymptomatic pseudo-aneurysms identified on routine delayed vascular imaging. One was treated successfully with endovascular coiling, however the second was too distal and required surgical clipping. There were no complications from either pseudo-aneurysm treatment. CONCLUSIONS: sEEG offers favorable morbidity, source localization, and seizure control in surgical lesions. We recommend surveillance imaging with CTA or MRA 3-6 months post operatively to rule out pseudoaneurysm formation given.