Delayed intracranial hematoma following stereoelectroencephalography for intractable epilepsy: case report

J Neurosurg Pediatr. 2012 Dec;10(6):525-8. doi: 10.3171/2012.8.PEDS12114. Epub 2012 Sep 28.

Abstract

Intracranial bleeding following stereoelectroencephalography (sEEG) is rare and commonly occurs early after electrode implantation. The authors report the case of a delayed intracranial hematoma following sEEG. This 10-year-old boy was referred to the authors' department to undergo an sEEG study for intractable epilepsy, with the hypothesis of a single localized epileptic zone in the left precentral region. To perform the exploration, 14 depth electrodes were implanted under stereotactic conditions. The results of a postoperative CT scan performed routinely at the end of the surgical procedure were normal. Eight days later, following an epileptic seizure, the child's condition worsened. The neurological examination revealed a left hemiparesis, agitation, and coma due to a right subdural hematoma with intraparenchymal bleeding. Despite a surgical evacuation followed by a decompressive craniectomy, the curative treatments were stopped 1 week later due to severe diffuse ischemic lesions found on MRI studies. This is the first observation of a delayed hematoma following an sEEG procedure. The mechanism underlying this complication remains unclear, but the rupture of a growing pseudoaneurysm caused by the electrode's implantation or the tearing of a neighboring vessel by an electrode were suspected. In consequence, physicians must remain vigilant during the entire sEEG recording period and probably also several days after electrode removal.

Publication types

  • Case Reports

MeSH terms

  • Anticonvulsants
  • Brain Ischemia / etiology*
  • Brain Ischemia / pathology
  • Cerebral Hemorrhage / etiology*
  • Cerebral Hemorrhage / physiopathology
  • Cerebral Hemorrhage / surgery
  • Child
  • Decompressive Craniectomy
  • Drug Resistance
  • Electrodes, Implanted / adverse effects*
  • Electroencephalography / adverse effects
  • Electroencephalography / instrumentation*
  • Epilepsy, Frontal Lobe / drug therapy
  • Epilepsy, Frontal Lobe / physiopathology*
  • Fatal Outcome
  • Hematoma, Subdural / etiology*
  • Hematoma, Subdural / physiopathology
  • Hematoma, Subdural / surgery
  • Humans
  • Interdisciplinary Communication
  • Intracranial Hypertension
  • Magnetic Resonance Imaging
  • Male
  • Postoperative Period
  • Stereotaxic Techniques
  • Time Factors
  • Tomography, X-Ray Computed
  • Withholding Treatment*

Substances

  • Anticonvulsants