Invasive EEG studies in tumor-related epilepsy: When are they indicated and with what kind of electrodes?
Invasive EEG studies in tumor-related epilepsy: When are they indicated and with what kind of electrodes?
复制标题
DOI：
10.1111/epi.12446
复制
发表时间：
2013-12-01
期刊：
影响因子：
5.6
通讯作者：
Menzler, Katja
中科院分区：
文献类型：
--
作者：
Rosenow, Felix;Menzler, Katja
肿瘤相关性癫痫（TRE）患者在癫痫手术病例中占重要比例。近期确定的术后癫痫发作结果的独立负面预测因素包括癫痫病程长、存在全身性强直 - 阵挛发作以及肿瘤切除不完全。在颞叶病例中，额外的海马切除术或皮质切除术可能会进一步改善结果。侵入性脑电图（EEG）记录（IEEG）可用于通过确定功能区皮质（EC）来指导切除，或确定潜在的磁共振成像（MRI）阴性致痫组织的范围。事实上，据报道，在因TRE接受癫痫手术的患者中，多达10%使用了侵入性记录。在仔细考虑癫痫手术的基本概念、IEEG的当前使用以及TRE中颞叶外和颞叶肿瘤的结果预测因素之后，我们提出以下观点：
（1）对于颞叶外TRE患者，只有当MRI病变（如果可行，包括其周围边缘）由于邻近或与EC重叠而无法完全切除时，IEEG才是必要的。在这些情况下，应对EC进行定位，以确定其与病变、刺激区和发作起始区的关系，从而最大限度地扩大病变切除术的范围。
（2）对于非优势侧颞叶TRE患者，数据表明，如果致痫性肿瘤（ETs）侵犯内侧颞叶结构，如果癫痫病程长，且发作频繁且致残，则应将这些结构纳入切除范围。
（3）对于优势侧颞叶TRE患者，我们建议如果内侧结构在功能和结构上完整，则保留这些结构，并且只有当它们在结构和功能上异常时才考虑切除。在这种情况下，没有足够的证据证明使用IEEG来确定致痫区的范围是合理的。这应留用于初次病变切除失败的病例。
Patients with tumor-related epilepsy (TRE) represent an important proportion of epilepsy surgery cases. Recently established independent negative predictors of postoperative seizure outcome are long duration of epilepsy, presence of generalized tonic-clonic seizures, and incomplete tumor resection. In temporal lobe cases, additional hippocampectomy or corticectomy may further improve outcome. Invasive electroencephalography (EEG) recordings (IEEG) may be indicated to guide the resection by defining eloquent cortex (EC) or to determine the extent of potentially magnetic resonance imaging (MRI)-negative epileptogenic tissue. In fact, invasive recordings are reportedly used in up to 10% of patients who are undergoing epilepsy surgery for TRE. Following careful consideration of the concepts underlying epilepsy surgery, the current use of IEEG, and the predictors of outcome in extratemporal and temporal tumors in TRE, we postulate the following> (1) In patients with extratemporal TRE, IEEG is necessary only if the MRI lesion (and if feasible a rim around it) cannot be completely resected because of adjacent or overlapping EC. In these cases, EC should be mapped to determine its relationships to the lesion, the irritative, and seizure-onset zones in order to maximize the extent of the lesionectomy. (2) In patients with nondominant temporal TRE, data suggest that if epileptogenic tumors (ETs) are encroaching on mesial temporal structures, if epilepsy duration is long, and seizures are frequent and disabling, these structures should be included in the resection. (3) In patients with dominant temporal TRE, we suggest leaving the mesial structures in place if they are functionally and structurally intact and to consider resecting these structures only if they are structurally and functionally abnormal. There is insufficient evidence justifying the use of IEEG to define the extent of the epileptogenic zone in such cases. This should be reserved for cases where an initial lesionectomy has failed.