Reduced complications from intracranial grid insertion by using a small grid size and a precise protocol during monitoring.

Autor: Rahman, Zebunnessa, Bleasel, Andrew, Bartley, Melissa, Dexter, Mark, Galea, Tony, Gill, Deepak, Soe, Samantha, Byth, Karen, Wong, Chong
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Zdroj: Acta Neurochirurgica; Feb2016, Vol. 158 Issue 2, p395-403, 9p, 7 Charts
Abstrakt: Background: A study of the risk factors associated with complications during intracranial EEG monitoring led to a change in protocol for monitoring and implantation at our centres. We conducted a study to identify any reduction in complications following the changed protocols involving the use of smaller subdural electrode arrays, continuous ICP monitoring, use of a central line, and intake of prophylactic antibiotics and dexamethasone. Methods: We prospectively collected data on patient outcomes between 2005 and 2012 (group B) compared with patients between 1988 and 2004 (group A) before the protocol changes. Results: Seventy-one patients in group A and 58 patients in group B underwent intracranial electrode implantation. Complications directly related to grids occurred in 25 % of group A vs. 8.6 % in group B (p < 0.05) and those indirectly related to grids were 11.2 % in group A vs. none in group B. The rate of transient complications requiring no treatment was 12.5 % in group A versus 1.7 % in group B. The rate of transient complications requiring treatment was 10 % in group A and 6.9 % in group B. There were two deaths in group A. The infection rate was higher in group B than group A (5.2 % vs. 2.8 %; p = 0.90). Since 2008 there have been no infective complications. Complications directly related to intracranial EEG monitoring were significantly reduced using the revised protocol ( p < 0.05). Regression analysis identifying only the size of the grids (≤4 × 8 grid arrays) implanted was an independent predictor of more complications in group A ( P < 0.05). Conclusions: Complication rates following intracranial implantation decreased following the use of a small grid size and adherence to a stringent protocol. [ABSTRACT FROM AUTHOR]
Databáze: Complementary Index
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