Stereoelectroencephalography: retrospective analysis of 742 procedures in a single centre
Stereoelectroencephalography: retrospective analysis of 742 procedures in a single centre
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DOI：
10.1093/brain/awz196
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发表时间：
2019-09-01
期刊：
影响因子：
14.5
通讯作者：
Francione, Stefano
中科院分区：
文献类型：
--
作者：
Cardinale, Francesco;Rizzi, Michele;Francione, Stefano
本手术系列的回顾性描述旨在报告在单个癫痫手术中心进行的20年立体脑电图（SEEG）活动的适应症、方法、癫痫发作结果、结局预测因素和并发症。从713例患者的742例SEEG手术中收集的数据进行了回顾和描述。SEEG引导切除术的长期癫痫发作结局定义为二项式变量：无（ILAE 1-2级）或复发（ILAE 3-6级）致残性癫痫发作。通过初步单/双变量分析，然后进行多变量logistic回归分析癫痫发作结局的预测因素。此外，这些受试者的癫痫发作的结果进行了比较，在1128例患者手术后，只有非侵入性的评价。还进行了生存分析，仅限于至少随访10年的患者。570例患者（79.9%）有切除手术指征。470例手术患者中有279例（59.4%）在切除手术后至少2年没有致残性癫痫发作。阴性磁共振和术后病变残留是癫痫复发的重要危险因素，而II型局灶性皮质发育不良、球囊细胞、胶质神经元肿瘤、海马硬化、癫痫发作时年龄较大和脑室周围结节性异位与癫痫发作无关。接受射频热凝的153例患者中有25例（16.3%）是最佳反应者。742例手术中有13例（1.8%）发生了非预期事件，包括3例（0.4%）严重并发症和1例死亡（0.1%）。总之，SEEG是一种安全有效的方法，用于最具挑战性的患者的致痫区的侵入性定义。尽管MRI阴性病例逐渐增加，但多年来无脑梗死患者的比例并未下降。
This retrospective description of a surgical series is aimed at reporting on indications, methodology, results on seizures, outcome predictors and complications from a 20-year stereoelectroencephalography (SEEG) activity performed at a single epilepsy surgery centre. Prospectively collected data from a consecutive series of 742 SEEG procedures carried out on 713 patients were reviewed and described. Long-term seizure outcome of SEEG-guided resections was defined as a binomial variable: absence (ILAE classes 1-2) or recurrence (ILAE classes 3-6) of disabling seizures. Predictors of seizure outcome were analysed by preliminary uni/bivariate analyses followed by multivariate logistic regression. Furthermore, results on seizures of these subjects were compared with those obtained in 1128 patients operated on after only non-invasive evaluation. Survival analyses were also carried out, limited to patients with a minimum follow-up of 10 years. Resective surgery has been indicated for 570 patients (79.9%). Two-hundred and seventy-nine of 470 patients operated on (59.4%) were free of disabling seizures at least 2 years after resective surgery. Negative magnetic resonance and post-surgical lesion remnant were significant risk factors for seizure recurrence, while type II focal cortical dysplasia, balloon cells, glioneuronal tumours, hippocampal sclerosis, older age at epilepsy onset and periventricular nodular heterotopy were significantly associated with seizure freedom. Twenty-five of 153 patients who underwent radio-frequency thermal coagulation (16.3%) were optimal responders. Thirteen of 742 (1.8%) procedures were complicated by unexpected events, including three (0.4%) major complications and one fatality (0.1%). In conclusion, SEEG is a safe and efficient methodology for invasive definition of the epileptogenic zone in the most challenging patients. Despite the progressive increase of MRI-negative cases, the proportion of seizure-free patients did not decrease throughout the years.