Outcomes of Stereoelectroencephalography-Guided Surgery in Patients with Drug-Resistant Epilepsy: A Single-Center Study

Abstract

Purpose: This study evaluated surgical outcomes after stereoelectroencephalography (SEE-G)-guided epilepsy surgery in pediatric patients with drug-resistant epilepsy (DRE) compared with outcomes after conventional subdural grid evaluation. Methods: We retrospectively analyzed pediatric patients with DRE who underwent resective epilepsy surgery at a single center from 2015 to 2023 and had at least 1 year of follow-up. The cohort comprised 36 patients evaluated with SEEG and 65 evaluated with subdural grids. We compared clinical characteristics, surgical outcomes, and procedure-related complications between groups. Results: The SEEG group included a higher proportion of patients with prior epilepsy surgery (25.0% vs. 13.8%). Despite this greater clinical complexity, postoperative seizure outcomes were significantly more favorable in the SEEG group: 75.0% achieved Engel class I (vs. 46.2% in the grid group; P=0.003) and 69.4% achieved International League Against Epilepsy class 1 (vs. 44.6%; P <0.001). SEEG was frequently used for reoperations, deep-seated lesions, and bilateral or multilobar cases. The duration of invasive monitoring was significantly shorter in the SEEG group (median 5 days vs. 7 days; P <0.001). Conclusion: SEEG appears to be an effective, safe, and minimally invasive evaluation modality for pediatric DRE. It was associated with favorable seizure outcomes even in complex, deep-seated, multilobar, or non-lesional cases, supporting its role as a valuable alternative to subdural grid-based intracranial monitoring.