Disconnection of the pathological connectome for multifocal epilepsy surgery
Disconnection of the pathological connectome for multifocal epilepsy surgery
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DOI：
10.3171/2017.6.jns17452
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发表时间：
2018-11-01
影响因子：
4.1
通讯作者：
Guger, Christoph
中科院分区：
文献类型：
--
作者：
Kamada, Kyousuke;Ogawa, Hiroshi;Guger, Christoph
目的近年来的影像学研究表明，难治性癫痫除了具有强致痫灶外，还涉及病理性功能网络。结合皮质-皮质诱发电位（CCEP）记录和纤维束成像是一种有用的策略，映射正常和病理网络的功能连接。在这项研究中，作者试图证明术前联合CCEP记录，高伽玛放射性（HGA）映射，纤维束造影术的手术计划，术中CCEP的措施，以确认选择性病理网络disconnectation.METHODS的有效性，作者治疗了4例顽固性癫痫。在第一次硬膜下网格植入手术前采集基于弥散张量成像的纤维束成像数据。在第一次手术后、第二次手术切除致痫灶前进行HGA和CCEP检查，术中持续监测CCEP。与语言功能相关的正常CCEP的平均负峰-1潜伏期为22.2 ± 3.5毫秒，而病理性CCEP潜伏期在18.1和22.4毫秒之间变化。所有病例的病理性CCEP在完全断开后均减少。在最后一次随访中，所有患者均处于术后长期无视神经病变状态，但仍有1例患者每隔一个月出现一次视觉先兆。结论：在本研究中，结合CCEP测量、HGA标测和纤维束成像，可大大促进病理网络的靶向断开。虽然CCEP记录需要技术专长，但它允许评估难治性癫痫的病理网络参与，并可能改善癫痫发作结局。
OBJECTIVE Recent neuroimaging studies suggest that intractable epilepsy involves pathological functional networks as well as strong epileptogenic foci. Combining cortico-cortical evoked potential (CCEP) recording and tractography is a useful strategy for mapping functional connectivity in normal and pathological networks. In this study, the authors sought to demonstrate the efficacy of preoperative combined CCEP recording, high gamma activity (HGA) mapping, and tractography for surgical planning, and of intraoperative CCEP measures for confirmation of selective pathological network disconnection.METHODS The authors treated 4 cases of intractable epilepsy. Diffusion tensor imaging-based tractography data were acquired before the first surgery for subdural grid implantation. HGA and CCEP investigations were done after the first surgery, before the second surgery was performed to resect epileptogenic foci, with continuous CCEP monitoring during resection.RESULTS All 4 patients in this report had measurable pathological CCEPs. The mean negative peak-1 latency of normal CCEPs related to language functions was 22.2 +/- 3.5 msec, whereas pathological CCEP latencies varied between 18.1 and 22.4 msec. Pathological CCEPs diminished after complete disconnection in all cases. At last follow-up, all of the patients were in long-term postoperative seizure-free status, although 1 patient still suffered from visual aura every other month.CONCLUSIONS Combined CCEP measurement, HGA mapping, and tractography greatly facilitated targeted disconnection of pathological networks in this study. Although CCEP recording requires technical expertise, it allows for assessment of pathological network involvement in intractable epilepsy and may improve seizure outcome.