• Anthony Stefanelli, Victor Sabourin, Kevin Hines, Caio Matias, Subhadra Acharya, Ashwini Sharan, and Chengyuan Wu.
• Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA. Electronic address: anthony.stefanelli@jefferson.edu.
• World Neurosurg. 2022 Aug 1; 164: e964-e969.

ObjectiveTo study the effect of preoperative digital subtractive angiography (DSA) for planning stereoelectroencephalography (sEEG) electrode trajectories on the rate of postoperative radiographic hemorrhage.MethodsA retrospective, single-center observational study was conducted examining every sEEG implantation consisting of 72 implantations of 1028 total electrodes with each patient having received a preoperative planning DSA. Postimplant imaging was analyzed for the presence of hemorrhage. Postoperative computed tomography were then merged and coregistered with preoperative DSA to determine if a collision or near-miss (within 1 mm) occurred between the perihemorrhage electrodes and a vessel. Statistical analysis was then conducted.ResultsSix patients (8.3%) had hemorrhage seen on computed tomography with a bleeding rate of 0.6% per electrode. Five patients were asymptomatic (6.94%) and one symptomatic (1.39%). One patient suffered permanent neurologic deficits, and there have been zero deaths. In the hemorrhage group, there were 3 subdural, 2 subarachnoid, and 2 intraparenchymal. All subdural and subarachnoid hemorrhages had electrodes that were found to collide or near-miss a vessel when compared with preoperative DSA. Half of the intraparenchymal hemorrhages had no obvious vessel in proximity to the electrodes. Our data show that preoperative DSA is a viable screening test and portends a 94.7% sensitivity and 53.6% specificity for predicting post operative radiographic hemorrhage.ConclusionsAnalysis of our sEEG series reveals a substantially lower rate of postimplant hemorrhage when compared with the recent cohort studies. Our data indicate that preoperative DSA may be efficacious in reducing the incidence of sEEG postimplant hemorrhages.Copyright © 2022 Elsevier Inc. All rights reserved.

15 keywords...

hide…