総説 てんかん外科における定位的頭蓋内脳波(SEEG)の有用性
総説 てんかん外科における定位的頭蓋内脳波(SEEG)の有用性
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立体定向颅内脑电图 (SEEG) 在癫痫手术中的作用
DOI：
10.11477/mf.1436204672
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发表时间：
2022
期刊：
影响因子：
--
通讯作者：
松本理器
中科院分区：
文献类型：
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作者：
小林勝哉;Juan Bulacio;Dileep R Nair;Jorge Gonzalez-Martinez;松本理器
精确定位“致痫区”是对耐药局灶性癫痫患者进行术前检查的目标。当无创评估结果不一致时，需要颅内脑电图记录。尽管硬膜下网格电极（SDG）在日本已被广泛使用，但立体脑电图（SEEG）最近才被引入。SEEG的原理是基于解剖-电-临床相关性来研究手术假设，这些假设主要是由癫痫符号学分析以及其他非侵入性调查驱动的。SEEG方法最重要的元素是制定植入前电极轨迹，考虑癫痫发作的解剖-电-临床相关性。如果植入前的假设不充分或不正确，SEEG记录将无法识别EZ。对癫痫的符会学进行详细的解剖-电-临床相关分析，特别是包括各种深层结构，如岛叶、包盖和扣带皮层，形成了SEEG植入策略的基础。植入的策略不是绘制脑叶/小叶，而是绘制癫痫网络，通常涉及多个脑叶，这表明SEEG的理论与SDG的理论完全不同。在此，我们将介绍seg的基础知识，特别是术前评估，并介绍一个有代表性的病例。
Precise localization of the" epileptogenic zone (EZ)" is the goal of presurgical investigations in patients with drug-resistant focal epilepsy. Intracranial electroencephalography recordings are required when noninvasive evaluation results are not consistent. Although subdural grid electrodes (SDG) have been widely used in Japan, stereoelectroencephalography (SEEG) has been recently introduced. The principle of SEEG is based on anatomo-electro-clinical correlations to investigate surgical hypotheses that are primarily driven by the analysis of seizure semiology as well as other noninvasive investigations. The most important element of the SEEG methodology is to formulate preimplantation electrode trajectories considering the anatomo-electro-clinical correlations of epileptic seizures. If the preimplantation hypotheses are insufficient or incorrect, SEEG recordings will not identify the EZ. A detailed analysis of seizure semiology with respect to anatomo-electro-clinical correlates, particularly including various deep structures, such as the insular, operculum, and cingulate cortex, forms the basis of the implantation strategy for SEEG. The strategy of implantation is not to map the lobes/lobules but the epileptic networks, which usually involve multiple lobes, indicating that the theory of SEEG is completely different from that of SDG. Herein, we introduce the basics of SEEG, especially presurgical evaluations, with a representative case presentation.