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Anchoring Depth Electrodes for Bedside Removal: A Break-Away Suturing Technique for Intracranial Monitoring

Gross, Robert E. MD, PhD*; Rowland, Nathan C. MD, PhD§; Sung, Edward K. MD; LaBorde, David V. MD*; Suleiman, Shadeah L. BS‖,#

doi: 10.1227/NEU.0b013e31825569c0
Operative Technique

BACKGROUND: Intracranial depth electrodes for epilepsy are easily dislodged during long-term monitoring unless adequately anchored, but a technique is not available that is both secure and allows easy explantation without reopening the incision.

OBJECTIVE: To describe a convenient and inexpensive method for anchoring depth electrodes that prevents migration and incidental pullout while allowing electrode removal at the bedside.

METHODS: An easily breakable suture (eg, MONOCRYL) is tied around both the depth electrode and a heavy nylon suture and anchored to a hole at the edge of the burr hole; the tails of both are tunneled together percutaneously. The “break-away” MONOCRYL suture effectively anchors the electrode for as long as needed. At the completion of the intracranial electroencephalography session, the 2 tails of the nylon suture are pulled to break their encompassing MONOCRYL anchor suture, thus freeing the depth electrode for easy removal.

RESULTS: The break-away depth electrode anchoring technique was used for 438 electrodes in 68 patients, followed by explantation of these and associated strip electrodes without reopening the incision. Only 1 electrode (0.2%) migrated spontaneously, and 3 depth electrodes (0.7%) fractured in 2 patients (2.9%) on explantation, necessitating open surgery to remove them in 1 of the patients (1.5%).

CONCLUSION: An easy and inexpensive anchoring configuration for depth electrodes is described that provides an effective and safe means of securing the electrodes while allowing easy explantation at the bedside.

ABBREVIATION: iEEG, intracranial electroencephalography

Departments of *Neurosurgery and

Emory University School of Medicine, Atlanta, Georgia

§Department of Neurological Surgery, University of California, San Francisco, California

Department of Biology, Georgia Institute of Technology, Atlanta, Georgia

#Department of Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts

Correspondence: Robert E. Gross, MD, PhD, Department of Neurosurgery, Emory University School of Medicine, 1365B Clifton Road NE, Suite 6200, Atlanta, GA 30322. E-mail: rgross@emory.edu

Received October 28, 2011

Accepted February 24, 2012

Copyright © by the Congress of Neurological Surgeons