Awad I A, Assirati J A, Burgess R, Barnett G H, Luders H
Department of Neurosurgery, Cleveland Clinic Foundation, Ohio 44195.
Neurol Res. 1991 Sep;13(3):177-83. doi: 10.1080/01616412.1991.11739987.
Non-invasive electroencephalographic (EEG) recording with scalp and sphenoidal leads is often insensitive to precise localization of ictal onset, and can be distorted by skull defects and underlying lesions or deformities of the brain. We present preliminary experience with epidural pegs and foramen ovale electrodes used in 30 cases of intractable partial epilepsy where non-invasive EEG did not define a zone of epileptogenesis with sufficient precision to recommend resection, or to dictate precise placement of depth electrodes or subdural girds. Custom designed mushroom shaped peg electrodes were implanted via 4.5 mm twist-drill skull holes for epidural recording from cortical areas of suspected epileptogenesis. Foramen ovale electrodes (flexible 3-contact leads) were introduced via percutaneous puncture of Meckel's cave cistern for recording from mesiotemporal regions. Chronic recording was performed for 4 to 26 days (mean 9.2 days). There were no serious complications and signal quality was excellent in every electrode. Based on interictal and ictal records, resective surgery was performed in 8 cases, more focused further invasive recording was recommended in 15 cases (with subsequent resective surgery), and surgical options were excluded in 7 cases. It is concluded that these electrodes of 'intermediate invasiveness' represent a safe and effective tool in the armamentarium for mapping complicated or elusive epileptic foci. They can be used in lieu of, in addition to, or prior to more invasive measures. Their greatest advantage lies in their relative safety and ability to survey extensive zones of suspected epileptogenesis so as to guide and focus further mapping and surgical intervention.
使用头皮和蝶骨电极进行的无创脑电图（EEG）记录通常对发作起始的精确定位不敏感，并且可能会因颅骨缺损、潜在病变或脑畸形而失真。我们介绍了在30例难治性局灶性癫痫中使用硬膜外电极和卵圆孔电极的初步经验，这些病例中无创EEG未能足够精确地确定癫痫发生区域以推荐切除，或确定深度电极或硬膜下网格的精确放置位置。定制设计的蘑菇形电极通过4.5毫米的颅骨麻花钻钻孔植入，用于从疑似癫痫发生的皮质区域进行硬膜外记录。卵圆孔电极（柔性三触点导线）通过经皮穿刺Meckel腔池引入，用于从中颞叶区域进行记录。进行了4至26天（平均9.2天）的慢性记录。没有严重并发症，每个电极的信号质量都很好。根据发作间期和发作期记录，8例患者进行了切除手术，15例患者建议进行更有针对性的进一步侵入性记录（随后进行切除手术），7例患者排除了手术选择。结论是，这些“中等侵入性”电极是用于绘制复杂或难以捉摸的癫痫病灶的安全有效工具。它们可以替代、补充或在更侵入性措施之前使用。它们最大的优势在于相对安全性以及能够对广泛的疑似癫痫发生区域进行探测，从而指导并聚焦进一步的绘图和手术干预。
