Drill Choice as a Modifiable Factor in Pediatric sEEG Safety

Purpose: Stereoelectroencephalography (sEEG) procedures require drilling serial burr holes for electrode placement. Key drilling characteristics include haptic feedback, ease of use, and time-efficient burr hole creation. Orthopedic drill bits are often repurposed for sEEG. We present a case series highlighting sEEG as an application for a new-to-market neurosurgery-tailored drill. Methods: We performed a retrospective chart review on patients who underwent sEEG at our institution from 2022-2023. Patients were grouped by type of drill, Phasor® (a disposable battery-operated drill 3.20-mm diameter, 210-mm usable length) or Stryker® (Orthopedic Drill Cordless). Results: Twelve patients underwent sEEG with the neurosurgery-tailored drill (2 unilateral and 10 bilateral); on average 10.7± 1.6 electrodes were placed per patient and mean operative duration was 162.9± 49 minutes. Tactile feel of bony layers and consistent drill time per burr hole (<15 seconds) was subjectively noted. No complications were noted. Five patients underwent sEEG with the Stryker® ^{orthopedic drill (2 unilateral and 3 bilateral); an average of 11± 2.9 electrodes were placed per patient, mean operative duration was 176.4± 18.9 minutes. Subjectively, drill time per burr hole was variable and increased in duration between the first and final hole. One patient incurred a skin burn at the drill site which led to wound dehiscence and infection requiring prolonged wound care and antibiotics. Conclusion: The Phasor ® drill offers a lightweight, reliable, consistent, safe and efficient option for sEEG burr hole creation and may be considered as an alternative to the Stryker ® orthopedic drill.}