Stereoelectroencephalography in the presurgical evaluation of focal epilepsy: A retrospective analysis of 215 procedures
Stereoelectroencephalography in the presurgical evaluation of focal epilepsy: A retrospective analysis of 215 procedures
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DOI：
10.1227/01.neu.0000176656.33523.1e
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发表时间：
2005-10-01
期刊：
影响因子：
4.8
通讯作者：
Lo Russo, G
中科院分区：
文献类型：
--
作者：
Cossu, M;Cardinale, F;Lo Russo, G
目的：报告立体脑电图（SEEG）在耐药局灶性癫痫患者术前评估中的适应症、手术技术、结果和发病率。对211例患者进行了215次多导脑内电极立体定向手术（4例患者进行了两次探查），这些患者显示出不同的局部不连贯模式，（发作间期/发作头皮脑电图）、临床（发作信号学）和解剖学（磁共振成像[MRI]）研究。MRI扫描显示134例患者（63%; 7例与内侧颞叶硬化相关）有病变，77例患者（37%; 14例与内侧颞叶硬化相关）无病变。共植入了2666个电极（平均每例患者12.4个）（175例手术单侧植入，40例手术双侧植入）。对于电极靶向，立体定向立体脑血管造影在所有患者中使用，再加上一个coregistered三维MRI扫描在108 patients.Results：一百八十三例（87%）预定切除手术后，SEEG记录，和174已接受手术至今。47例患者（27%）的切除部位为颞叶，55例患者（31.6%）为额叶，14例患者（8%）为顶叶，1例患者（0.6%）为枕叶，1例患者（0.6%）为罗兰叶，56例患者（32.2%）为多叶。随访期超过12个月的165例患者的癫痫发作结局（恩格尔的分类）为：I级，56.4%; II级，15.1%; III级，10.9%; IV级，17.6%。结果与MRI扫描结果（P = 0.0001）和病灶切除完整性（P = 0.038）显著相关。死亡相关的电极植入发生在12个程序（5.6%），严重的永久性赤字从脑内出血在2（1%）patients.CONCLUSION：SEEG是一个有用的和相对安全的工具，在评价手术候选人时，非侵入性调查未能定位致痫区。基于SEEG的切除手术可能会在特别复杂的耐药性癫痫中提供优异的结果。
OBJECTIVE: To report on indications, surgical technique, results, and morbidity of stereoelectroencephalography (SEEG) in the presurgical evaluation of patients with drug-resistant focal epilepsy.METHODS: Two-hundred fifteen stereotactic implantations of multilead intracerebral electrodes were performed in 211 patients (4 patients were explored twice), who showed variable patterns of localizing incoherence among electrical (interictal/ictal scalp electroencephalography), clinical (ictal semeiology), and anatomic (magnetic resonance imaging [MRI]) investigations. MRI scanning showed a lesion in 134 patients (63%; associated with mesial temporal sclerosis in 7) and no lesion in 77 patients(37%; with mesial temporal sclerosis in 14 patients). A total of 2666 electrodes (mean, 12.4 per patient) were implanted (unilaterally in 175 procedures and bilaterally in 40). For electrode targeting, stereotactic stereoscopic cerebral angiograms were used in all patients, coupled with a coregistered three-dimensional MRI scan in 108 patients.RESULTS: One hundred eighty-three patients (87%) were scheduled for resective surgery after SEEG recording, and 174 have undergone surgery thus far. Resections sites were temporal in 47 patients (27%), frontal in 55 patients (31.6%), parietal in 14 patients (8%), occipital in one patient (0.6%), rolandic in one patient (0.6%), and multilobar in 56 patients (32.2%). Outcome on seizures (Engel's classification) in 165 patients with a follow-up period of more than 12 months was: Class I, 56.4%; Class II, 15.1 %; Class III, 10.9%; and Class IV, 17.6%. Outcome was significantly associated with the results of MRI scanning (P = 0.0001) and with completeness of lesion removal (P = 0.038). Morbidity related to electrode implantation occurred in 12 procedures (5.6%), with severe permanent deficits from intracerebral hemorrhage in 2 (1%) patients.CONCLUSION: SEEG is a useful and relatively safe tool in the evaluation of surgical candidates when noninvasive investigations fail to localize the epileptogenic zone. SEEG-based resective surgery may provide excellent results in particularly complex drug-resistant epilepsies.