Occipitotemporal hippocampal depth electrodes in intracranial epilepsy monitoring: safety and utility
Occipitotemporal hippocampal depth electrodes in intracranial epilepsy monitoring: safety and utility
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DOI：
10.3171/2012.9.jns112221
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发表时间：
2013-02-01
影响因子：
4.1
通讯作者：
Roberts, David W.
中科院分区：
文献类型：
--
作者：
Bekelis, Kimon;Desai, Atman;Roberts, David W.
对象。颅内监测癫痫已被证明可以提高诊断的准确性，并为难治性癫痫的手术治疗提供定位信息。作者探讨了在更先进的成像技术时代海马体深度电极的实用性。1988年至2010年间，有100例患者接受了枕颞海马深度电极（OHDE）植入作为侵入性癫痫监测的一部分，并对其图表进行回顾性分析。作者的技术包括立体定向引导（使用Leksell模型G框架）植入一个12接触深度电极，沿着海马体的长轴定向，通过枕部麻花钻孔。100例接受颅内检查的患者（平均年龄35.0岁[范围13-58岁]，51%男性）中，84例行癫痫病灶切除术。磁共振成像显示27%的患者为内侧颞叶硬化（MTS）， 55%的患者无MTS表现为异常，18%的患者表现为正常。一名患者在电极束周围出现少量无症状的枕骨出血。在最终接受标准或选择性颞叶切除术的患者中，有45.7%的患者能够使用ohde进行癫痫切除术。手术期间，海马形成得以保留，因为从深度电极获得的数据显示，14%的术前颞部定位患者没有或只有继发性损伤。在有MTS影像学证据的患者中，12%的患者使用了ohde，在2年的随访中，83%接受切除术的患者的Engel分级为I级（68%）或II级（15%）。ohde用于颅内癫痫监测具有良好的风险概况，并且在作者的经验中，它被证明是颅内检查的一个有价值的组成部分。ohde的使用可以为某些癫痫灶的切除提供唯一的证据，也可以导致海马保留或防止其他患者可能不成功的切除。(http://thejns.org/doi/abs/10.3171/2012.9.JNS112221)
Object. Intracranial monitoring for epilepsy has been proven to enhance diagnostic accuracy and provide localizing information for surgical treatment of intractable seizures. The authors investigated the usefulness of hippocampal depth electrodes in the era of more advanced imaging techniques.Methods. Between 1988 and 2010, 100 patients underwent occipitotemporal hippocampal depth electrode (OHDE) implantation as part of invasive seizure monitoring, and their charts were retrospectively reviewed. The authors' technique involved the stereotactically guided (using the Leksell model G frame) implantation of a 12-contact depth electrode directed along the long axis of the hippocampus, through an occipital twist drill hole.Results. Of the 100 patients (mean age 35.0 years [range 13-58 years], 51% male) who underwent intracranial investigation, 84 underwent resection of the seizure focus. Magnetic resonance imaging revealed mesial temporal sclerosis (MTS) in 27% of patients, showed abnormal findings without MTS in 55% of patients, and showed normal findings in 18% of patients. One patient developed a small asymptomatic occipital hemorrhage around the electrode tract. The use of OHDEs enabled epilepsy resection in 45.7% of patients who eventually underwent standard or selective temporal lobe resection. The hippocampal formation was spared during surgery because data obtained from the depth electrodes showed no or only secondary involvement in 14% of patients with preoperative temporal localization. The use of OHDEs prevented resections in 12% of patients with radiographic evidence of MTS. Eighty-three percent of patients who underwent resection had Engel Class I (68%) or II (15%) outcome at 2 years of follow-up.Conclusions. The use of OHDEs for intracranial epilepsy monitoring has a favorable risk profile, and in the authors' experience it proved to be a valuable component of intracranial investigation. The use of OHDEs can provide the sole evidence for resection of some epileptogenic foci and can also result in hippocampal sparing or prevent likely unsuccessful resection in other patients. (http://thejns.org/doi/abs/10.3171/2012.9.JNS112221)