Cossu Massimo, Cardinale Francesco, Castana Laura, Citterio Alberto, Francione Stefano, Tassi Laura, Benabid Alim L, Lo Russo Giorgio
Claudio Munari Center for Epilepsy Surgery, Ospedale Niguarda-Ca' Granda, Milan, Italy.
Neurosurgery. 2005 Oct;57(4):706-18; discussion 706-18.
To report on indications, surgical technique, results, and morbidity of stereoelectroencephalography (SEEG) in the presurgical evaluation of patients with drug-resistant focal epilepsy.
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.
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.
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.
报告立体定向脑电图（SEEG）在药物难治性局灶性癫痫患者术前评估中的适应证、手术技术、结果及并发症。
对211例患者（4例患者接受了两次探查）进行了215次多导联脑内电极立体定向植入，这些患者在电生理（发作间期/发作期头皮脑电图）、临床（发作期症状学）和解剖学（磁共振成像[MRI]）检查中表现出不同的定位不一致模式。MRI扫描显示134例患者（63%；7例伴有内侧颞叶硬化）有病变，77例患者（37%；14例伴有内侧颞叶硬化）无病变。共植入2666根电极（平均每位患者12.4根）（175例为单侧植入，40例为双侧植入）。对于电极靶向，所有患者均使用立体定向立体脑血管造影，108例患者结合了配准的三维MRI扫描。
183例患者（87%）在SEEG记录后计划进行切除性手术，迄今为止174例患者已接受手术。切除部位为颞叶47例（27%），额叶55例（31.6%），顶叶14例（8%），枕叶1例（0.6%），中央区1例（0.6%），多叶56例（32.2%）。165例随访时间超过12个月患者的癫痫发作结果（Engel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）和病变切除的完整性（P = 0.038）显著相关。与电极植入相关的并发症发生在12例手术中（5.6%），2例（1%）患者因脑出血出现严重永久性神经功能缺损。
当无创检查未能定位致痫区时，SEEG是评估手术候选者的一种有用且相对安全的工具。基于SEEG的切除性手术在特别复杂的药物难治性癫痫中可能会取得优异的效果。
