International Survey of Stereo-EEG Practices: A Comparative Analysis of Epilepsy Surgery Centers in Europe and North America

Purpose: Stereoelectroencephalography (SEEG) is widely used for presurgical evaluation in epilepsy, yet practice patterns vary substantially across centers, contributing to heterogeneity in the literature. We examined differences in SEEG experience, techniques, and complications across Europe and North America centers. Methods: An electronic 39-item REDCap survey was distributed to centers participating in the American Stereo-EEG Consortium and EpiCARE Consortium. The survey assessed center characteristics, electrode planning and implantation, monitoring practices, and complications. Results: Sixty-six centers responded, including 38 from North America and 28 from Europe. North American centers more frequently used nurse-led ictal and postictal assessments (16/38 vs. 5/28; P = 0.06) and robotic image-guided implantation systems (37/38 vs. 17/28; P < 0.001), with a trend toward higher case volumes. Compared with European centers, North American programs were less likely to have over 15 years of SEEG experience (6/38 vs. 12/28; P = 0.015), fewer dedicated SEEG readers (12/38 vs. 25/28; P < 0.001), and less frequent use of SEEG-guided radiofrequency ablation (13/38 vs. 25/28; P < 0.01). Symptomatic hemorrhage was more frequently reported among North American centers in the unadjusted analysis (9/38 vs. 1/28; p = 0.035); however, the regional difference was no longer statistically significant after adjustment for center SEEG experience and annual case volume. Conclusions: Significant differences exist between North American and European SEEG practices. North American centers more commonly use robotic implantation and manage higher volume, whereas European centers demonstrate greater experience and more frequent use of SEEG-guided ablation. These findings support the need for standardized protocols to improve safety and outcomes.