Early Feasibility and Complication Analysis of Stereo-electroencephalography (SEEG) Electrode Removal in an Extraoperative Clinical Setting

Introduction: Stereotactic electroencephalography (SEEG) entails the implantation of intracortical electrodes to accurately localize the epileptogenic zone (EZ) and is well-established for its safety and efficacy in implantation. However, there is a significant gap in research comparing the safety, complications, and feasibility of various electrode removal techniques. This study aims to assess the feasibility and clinical applicability of intraoperative versus extraoperative (bedside) SEEG electrode removal.

Methods: Our early feasibility analysis retrospectively reviewed 117 consecutively SEEG patients who have previously undergone SEEG implantation and removal at our institution's medical center. We compare 101 intraoperative removal cases (1,426 electrodes) and 16 extraoperative removal cases (198 electrodes). Results in regards of patient demographics, cortical distribution of electrodes, occurrences of complications, feasibility of extraoperative (bedside) removal were statistically compared between the two groups.

Results: Our study findings reveal comparable patient demographics across both groups and demonstrate low complication rates of 1.98% for intraoperative and 0.00% for extra-operative removals, with a combined rate of 1.71%. Notably, zero cases of infection were observed in both settings. Furthermore, our study indicates a significantly reduced use of sedation in the extra-operative group, which may contribute to higher patient comfort levels, as they continue their evaluation without the need for further sedatives. The extraoperative bedside approach may also have practical advantages. By introducing the alternative—extraoperative explants— the need for an OR is eliminated, along with the nuances of intraoperative procedures. This alternative provides greater flexibility in scheduling electrode removals, increasing operational efficiency and optimizing the use of hospital resources.

Conclusion : With the appropriate indications, the extraoperative removal of SEEG electrodes appears to be a feasible and safe alternative to the intraoperative method. It presents potential advantages in optimizing patient flow within epilepsy monitoring units, improving operational efficiency, and potentially reducing healthcare costs while promoting patient comfort. Future research is essential to validate these findings further and refine the bedside technique for broader clinical application.