Efficacy of and morbidity associated with stereoelectroencephalography using computerized tomography - or magnetic resonance imaging-guided electrode implantation
Efficacy of and morbidity associated with stereoelectroencephalography using computerized tomography - or magnetic resonance imaging-guided electrode implantation
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DOI：
10.3171/jns.2006.104.4.483
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发表时间：
2006-04-01
影响因子：
4.1
通讯作者：
Andermann, F
中科院分区：
文献类型：
--
作者：
de Almeida, AN;Olivier, A;Andermann, F
目的。本文的目的是使用现代成像方法来定义立体脑电图的一般疗效和发病率，并详细说明与特定脑叶相关的风险。方法。蒙特利尔神经病学研究所收治的所有患者均由一名外科医生 (A.O.) 接受了计算机断层扫描或磁共振成像引导的电极植入手术。如果获得的信息足以做出支持或反对手术的决定，则该手术被认为是有效的。217 名患者接受了 224 次植入，植入了 3022 个电极。各叶相关并发症如下：颞叶两处脓肿（0.54%）；额叶，1个脓肿和3个血肿（1.4%）；和枕叶，电极取出后 1 周发现 1 例低信号病变（2.6%）。与血肿相关的重要危险因素是额叶植入（p < 0.05）和使用四个或更多植入电极（p < 0.025）。一般并发症包括以下内容： 26 名患者在监测期间出现精神症状；一名患者，脑膜炎；四、头皮蜂窝织炎患者；还有两名患者，在 20 世纪 80 年代初进行血管造影时出现偏瘫。其中一名患者维持轻度偏瘫，是整个系列中唯一出现永久性神经后遗症的病例。记录期间获得的数据支持 178 名患者 (79.5%) 的手术指征，排除 37 名患者 (16.5%) 的手术选择，9 名患者 (4%) 的手术选择不满意。因此，先前定义的总体疗效为 96%。结论。立体脑电图是一种有效的方法，相关发病率较低。双侧颞叶探查的发病率约为 1%。在额叶植入四个或更多电极时发生血肿的风险较高。
Object. The purpose of this paper was to define the general efficacy of and morbidity associated with stereoelectroencephalography using modern methods of imaging and to particularize the risks related to specific lobes of the brain.Methods. All patients admitted to the Montreal Neurological Institute who had undergone either computerized tomography- or magnetic resonance imaging-guided electrode implantation by one surgeon (A.O.) were reviewed. The procedure was considered efficient if the obtained information was sufficient to make a decision either in support of or against surgery.Two hundred seventeen patients underwent 224 implantations with 3022 electrodes. Complications related to each lobe were as follows: temporal lobe, two abscesses (0.54%); frontal lobe, one abscess and three hematomas (1.4%); and occipital lobe, one hypointense lesion found 1 week after electrode explantation (2.6%). Significant risk factors associated with hematomas were implantation in the frontal lobe (p < 0.05) and the use of four or more implanted electrodes (p < 0.025).General complications included the following: 26 patients, psychiatric symptoms during monitoring; one patient, meningitis; four patients, scalp cellulitis; and two patients, hemiparesis during angiography in the early 1980s. One of these latter patients maintained a mild hemiparesis and represents the only case of permanent neurological sequela in the entire series. Data obtained during recordings supported an indication for surgery in 178 patients (79.5%), excluded a surgical option in 37 patients (16.5%), and were unsatisfactory in nine patients (4%). Thus, the overall efficacy as defined previously was 96%.Conclusions. Stereoelectroencephalography is an efficient procedure with low associated morbidity. Bilateral exploration of the temporal lobes has a morbidity rate of approximately 1%. A higher risk of hematomas occurs with the implantation of four or more electrodes in the frontal lobes.