De Almeida Antonio Nogueira, Olivier André, Quesney Felipe, Dubeau François, Savard Ghislaine, Andermann Frederick
Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, Brazil.
J Neurosurg. 2006 Apr;104(4):483-7. doi: 10.3171/jns.2006.104.4.483.
The purpose of this paper was to define the general efficacy of and morbidity associated with stereoelectroencephalography using modem methods of imaging and to particularize the risks related to specific lobes of the brain.
All patients admitted to the Montreal Neurological Institute who had undergone either computerized tomography- or magnetic resonance imaging-guided electrode implantation by one surgeon (A.O.) were reviewed. The procedure was considered efficient if the obtained information was sufficient to make a decision either in support of or against surgery. Two hundred seventeen patients underwent 224 implantations with 3022 electrodes. Complications related to each lobe were as follows: temporal lobe, two abscesses (0.54%); frontal lobe, one abscess and three hematomas (1.4%); and occipital lobe, one hypointense lesion found 1 week after electrode explantation (2.6%). Significant risk factors associated with hematomas were implantation in the frontal lobe (p < 0.05) and the use of four or more implanted electrodes (p < 0.025). General complications included the following: 26 patients, psychiatric symptoms during monitoring; one patient, meningitis; four patients, scalp cellulitis; and two patients, hemiparesis during angiography in the early 1980s. One of these latter patients maintained a mild hemiparesis and represents the only case of permanent neurological sequela in the entire series. Data obtained during recordings supported an indication for surgery in 178 patients (79.5%), excluded a surgical option in 37 patients (16.5%), and were unsatisfactory in nine patients (4%). Thus, the overall efficacy as defined previously was 96%.
Stereoelectroencephalography is an efficient procedure with low associated morbidity. Bilateral exploration of the temporal lobes has a morbidity rate of approximately 1%. A higher risk of hematomas occurs with the implantation of four or more electrodes in the frontal lobes.
本文旨在利用现代成像方法确定立体脑电图的总体疗效及相关发病率，并详述与大脑特定脑叶相关的风险。
回顾了所有在蒙特利尔神经病学研究所由同一位外科医生（A.O.）进行计算机断层扫描或磁共振成像引导下电极植入的患者。如果所获信息足以支持或反对手术决策，则该手术被视为有效。217例患者接受了224次植入，共使用3022根电极。与各脑叶相关的并发症如下：颞叶，2例脓肿（0.54%）；额叶，1例脓肿和3例血肿（1.4%）；枕叶，电极取出1周后发现1例低信号病变（2.6%）。与血肿相关的显著风险因素为额叶植入（p<0.05）以及使用4根或更多植入电极（p<0.025）。一般并发症包括：26例患者在监测期间出现精神症状；1例患者发生脑膜炎；4例患者出现头皮蜂窝织炎；20世纪80年代早期，2例患者在血管造影期间出现偏瘫。其中1例患者遗留轻度偏瘫，这是整个系列中唯一一例永久性神经后遗症。记录期间获得的数据支持178例患者（79.5%）的手术指征，排除37例患者（16.5%）的手术选择，9例患者（4%）的数据不令人满意。因此，如前所述的总体有效率为96%。
立体脑电图是一种有效的检查方法，相关发病率较低。双侧颞叶探查的发病率约为1%。在额叶植入4根或更多电极时，发生血肿的风险较高。
