Abstract
Complications can be defined as unexpected, unwanted, and uncommon events associated with either a diagnostic or therapeutic procedure. However, with respect to differences in definition, grading, and study methodology, data provided on complications noticeably vary between different institutions. Extraoperative invasive EEG recordings are associated with complication rates of 1–3% with the use of depth electrodes, 2–5% with subdural strip electrodes, and 10–15% using grid electrodes. The mortality of temporal resections is below 1%, temporary morbidity ranges between 5% and 10%, and permanent morbidity between 3% and 5%. Most minor adverse effects refer to upper quadrantic or subquadrantic hemianopia as observed in around 50% of patients. Permanent morbidity in frontal and parietal resections ranges between 10% and 15% and may be as high as 30–40% in Rolandic resections. Visual field deficits exceeding superior quadrantanopia occur in 40–50% of occipital lesionectomies or extended lesionectomies. Mortality in extratemporal procedures is in the range of 1–2%. For insular resections, temporary neurological morbidity between 20% and 40% and permanent morbidity between 5% and 10% have been reported. With modified hemispherectomy/hemispherotomy techniques, mortality mainly ranges between 2% and 4%, and there are no essential differences between the approaches used. Morbidity rate is in the range of 30–50%. Callosotomy represents the most invasive non-resective surgical procedure and is associated with a mortality rate of 1–2%, a temporary morbidity in the range of 10–20%, and a permanent morbidity of 5–10%. Serious morbidity with vagal nerve stimulation is below 1%, and between 2% and 4% with deep brain and responsive stimulation. Permanent morbidity of curative stereotactic strategies highly depends on the target and amounts to 30–40% with hypothalamic hamartomas and 3–4% with other targets. Overall, complication rates have noticeably decreased over the last decades.
Wise men learn by others’ harms; fools by their own
Benjamin Franklin
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Zentner, J. (2020). Complications. In: Surgical Treatment of Epilepsies. Springer, Cham. https://doi.org/10.1007/978-3-030-48748-5_15
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