Sebastiano F, Di Gennaro G, Esposito V, Picardi A, Morace R, Sparano A, Mascia A, Colonnese C, Cantore G, Quarato P P
Epilepsy Surgery Unit, IRCCS NEUROMED, via Atinense, n 18, 86077 Pozzilli (IS), Italy.
Clin Neurophysiol. 2006 Feb;117(2):341-7. doi: 10.1016/j.clinph.2005.10.005. Epub 2006 Jan 3.
To evaluate a novel method for localization of subdural electrodes in presurgical assessment of patients with drug-resistant focal epilepsy.
We studied eight consecutive patients with posterior epilepsy in whom subdural electrodes were implanted for presurgical evaluation. Electrodes were detected on post-implantation brain CT scans through a semiautomated procedure based on a MATLAB routine. Then, post-implantation CT scans were fused with pre-implantation MRI to localize the electrodes in relation to the underlying cortical structures. The reliability of this procedure was tested by comparing 3D-rendered MR images of the electrodes with electrode position as determined by intraoperative digital photography.
In each patient, all electrodes could be correctly localized and visualized in a stereotactic space, thus allowing optimal surgery planning. The agreement between the procedure-generated images and the digital photographs was good according to two independent raters. The mean mismatch between the 3D images and the photographs was 2 mm.
While our findings need confirmation on larger samples including patients with anterior epilepsy, this procedure allowed to localize subdural electrodes and to establish the spatial relationship of each electrode to the underlying brain structure, either normal or damaged, on brain convessity, basal and medial cortex.
Being simple, rapid, unexpensive, and reliable, this procedure holds promise to be useful to optimize epilepsy surgery planning.
评估一种在耐药性局灶性癫痫患者术前评估中定位硬膜下电极的新方法。
我们研究了连续8例后部癫痫患者，他们接受了硬膜下电极植入术以进行术前评估。通过基于MATLAB程序的半自动方法在植入后脑部CT扫描上检测电极。然后，将植入后CT扫描与植入前MRI融合，以确定电极相对于潜在皮质结构的位置。通过将电极的3D渲染MR图像与术中数字摄影确定的电极位置进行比较，测试该程序的可靠性。
在每位患者中，所有电极都能在立体定向空间中正确定位并可视化，从而实现最佳手术规划。根据两名独立评估者的评估，该程序生成的图像与数字照片之间的一致性良好。3D图像与照片之间的平均偏差为2毫米。
虽然我们的研究结果需要在包括前部癫痫患者在内的更大样本上得到证实，但该程序能够定位硬膜下电极，并确定每个电极与大脑凸面、基底和内侧皮质上正常或受损的潜在脑结构之间的空间关系。
该程序简单、快速、廉价且可靠，有望用于优化癫痫手术规划。
