Delayed stereo-EEG electrode removal after thermocoagulation: haemorrhage risk examined

A study published online on 14 October 2026 in Epilepsy Research asks a question that every stereo-EEG programme performing radiofrequency thermocoagulation (RFTC) now faces in writing: does leaving intracranial electrodes in place longer after the coagulation procedure increase the risk of intracranial haemorrhage?

The paper, authored by Nicholas Tjangdjaja, Heath R. Pardoe, Linda J. Dalic, Kristian J. Bulluss and John S. Archer, examines the safety profile of delayed electrode removal in patients who undergo RFTC through implanted stereo-EEG depth electrodes. The question matters because RFTC is typically delivered through the same depth electrodes used for the diagnostic SEEG evaluation, which creates a scheduling decision at the bedside: remove the leads immediately after coagulation, or leave them in place for continued monitoring.

Why does electrode timing matter after RFTC?

Stereo-EEG implantation carries its own baseline haemorrhage risk, and thermocoagulation adds a second insult along the electrode track. The clinical logic of delay is straightforward. Teams that keep electrodes in situ after RFTC can verify the functional effect of the lesions, continue recording from the same contacts, and deliver additional coagulations if the initial effect falls short. The trade-off is additional days with intracranial hardware in place, and that is precisely the exposure the authors set out to interrogate.

For monitoring units, the operational question is whether an extended dwell time changes the complication profile enough to alter standard operating procedure. The study frames haemorrhage as the endpoint of interest, which aligns with the complication that carries the greatest weight in SEEG consent discussions.

What does this change for reading-room and monitoring-unit practice?

The title itself signals that the field lacks settled guidance on this point, and the authors position the work as a direct test of the assumption that delayed removal is neutral with respect to bleeding risk. Programmes running same-day removal after RFTC, and programmes that routinely stage a second coagulation session through retained electrodes, will read this paper differently — but both will want the haemorrhage rates broken out by removal timing, which is the comparison the study was designed to deliver.

The investigators bring combined expertise across neurophysiology, epilepsy surgery and neuroimaging: Tjangdjaja and Pardoe are known for quantitative EEG and imaging work, Dalic and Archer for clinical epilepsy and neurophysiology at Australian centres, and Bulluss for functional neurosurgery. The collaboration spans the full SEEG pathway, from implantation planning through thermocoagulation delivery.

What is investigational and what is standard here?

SEEG and RFTC through implanted depth electrodes are established techniques at major epilepsy surgery centres, not investigational devices. The open question in this paper concerns procedural timing and its safety trade-off, not the technology itself. That distinction matters for how centres generalise the findings: this is a protocol question, answerable within existing practice, and potentially answerable differently at different centres depending on electrode trajectory planning, coagulation parameters and patient selection.

Epilepsy Research published the study online on 14 October 2026, making it available to the clinical neurophysiology community ahead of print assignment.

What should practitioners watch next?

Readers should evaluate the reported haemorrhage rates against their own institutional SEEG complication data, and consider whether the timing of electrode removal after RFTC deserves a place in their programme's written protocol. As more centres adopt SEEG-guided thermocoagulation as an alternative or adjunct to open resection, safety data on the full procedural window — from implantation through final electrode extraction — will increasingly shape how these interventions are staged.

Note to readers: this report is based on the publication record (title, authors, journal, publication date) available at the time of writing; readers should consult the full text in Epilepsy Research for the cohort size, haemorrhage rates and statistical findings, which were not available in the summary record reviewed here.