Good afternoon, and thanks so much for the opportunity to speak about variation in pediatric stereo EEG practice among pediatric neurosurgeons in the U.S. On behalf of my co-authors from Birmingham, Jeff Blount and Jacob Leppard, as well as our student Joshua Katz. Stereo EEG use has rapidly increased in pediatric neurosurgery, and we hypothesize that most surgeons performing these surgeries are not formally trained in it. Most programs are relatively inexperienced, and therefore, the implementation of this practice would vary widely. There are no large registries or multi-centered trials currently documenting this activity, but in a 35-question survey, we believe we have captured a very rich data set describing practice from big-picture approaches down to technical nuances. We recognize the shortcomings of survey data in general, so I won't belabor them here, but with 61 pediatric fellowship-trained epilepsy surgeons in the U.S. as respondents, we believe these data likely represent the current practice at a reasonably high fidelity. What's striking to us is that these results depict a wide variation in pediatric stereo EEG plans, highlighting stark differences in the philosophy and approach of pediatric epilepsy programs around the U.S. I have no disclosures. In 35 questions, there's a lot of data that I have to leave out. The categories of questions were broadly demographics, training and experience. I'll leave out the technique and outcomes-related questions in the interest of time and focus on what we believe to be the most interesting, responses regarding electrode location, that is, stereo EEG plans. We cast a broad net for inclusion and sent an electronic survey to 128 potential pediatric epilepsy surgeons in the U.S. Univariate linear regression was used to evaluate associations, and p-values less than 0.05 were used. Sixty-one out of 128, or 48%, of people sent a survey responded from a wide geographic distribution. All respondents completed a pediatric neurosurgery fellowship. Only 18% did an epilepsy fellowship, consistent with our hypothesis. Eighty-nine percent were currently using stereo EEG in their practice. The others were using grids. Of those using stereo EEG, 57% reported not having trained in stereo EEG in residency or fellowship. Seventy-two percent of stereo EEG programs had been in existence for less than five years. Thirty-one percent were performing fewer than five cases per year, while eight percent were performing at least 25 cases per year. Duration of program and volume of program were not correlated. Two-thirds were performing over 70% of their invasive monitoring with stereo EEG. This means a lot of programs without a ton of experience with near complete conversion from grids to stereo EEG. Here you see that cases per year was statistically correlated with younger age of youngest patient, perhaps suggesting that comfort with smaller children comes with volume. We asked what the median number of electrodes placed is. Here you see a statistically significant positive association between volume of stereo EEG cases per year and the median number of electrodes implanted, suggesting that comfort with more electrodes comes with volume. The average was 12, but less than two-thirds of respondents were in the 9 to 14 range. To me, this is the biggest take-home point of our study that supports our original hypothesis that there are fundamental philosophical differences among programs about epilepsy, networks, and the treatment of drug-resistant epilepsy. Nineteen percent reported implanting a median of five to eight electrodes, while 17% reported 15 to 18. These are not merely outliers or people who misread the question. This is over one-third of respondents. We contend that these groups are thinking about epilepsy and clearly managing epilepsy in very different ways. To further illustrate this point, 16% indicated that their implants are almost never bilateral, whereas 8% indicated that they are almost always bilateral. Again, very different approaches to epilepsy patients. Furthermore, 14% reported almost always using dedicated insular electrodes, while 12% almost never do. So I'd like to thank the respondents, of course, and my co-authors again, and I look forward to our panel discussion. Thank you.

pediatric stereo EEG practice

pediatric neurosurgeons

formal training

variation in practice

pediatric epilepsy surgeons