Epilepsy Center, Dept. of Neurology.
Epileptic Disord. 2010 Mar;12(1):48-53. doi: 10.1684/epd.2010.0297. Epub 2010 Mar 1.
To evaluate the clinical utility of epidural and foramen-ovale recordings and associated morbidity in the pre-surgical evaluation of epilepsy.
We retrospectively analysed 59 epilepsy patients, who underwent recordings with epidural (n = 59) and foramen-ovale electrodes (n = 46) as part of their pre-surgical evaluation between 1990-1999. The epidural and foramen-ovale evaluation was based on the results of the non-invasive EEG-video recordings in patients, in whom non-invasive evaluation failed to localise seizure onset (75%, 44 patients) or where EEG, and imaging studies were discrepant (25%, 15 patients) but allowed a testable hypothesis on the seizure onset zone.
Most patients (n = 57) were evaluated between 1990-1994. Only two patients were evaluated later. The results of the epidural (n = 559) and foramen-ovale (n = 83) electrode recordings allowed us to proceed to resective epilepsy surgery in 31% (n = 18) and to exclude further invasive evaluation in 15% (n = 9) of the patients. In 49% (n = 29) of the patients the results guided further invasive recordings using subdural and/or depth electrodes. For only three patients no additional information was gained by the electrode recordings. Temporary morbidity included local infection (epidural; n = 1) and facial pain (foramen ovale; n = 1) but no permanent complication occurred.
Epidural and foramen-ovale electrodes have almost been abandoned in recent years, most likely because of the improvement of neuroimaging techniques such as MRI, PET and ictal SPECT. However, in selected patients, epidural electrodes and foramen-ovale electrodes are either useful as a measure to avoid invasive evaluation or serve to guide invasive evaluation.
评估硬膜外和卵圆孔记录及其相关发病率在癫痫术前评估中的临床实用性。
我们回顾性分析了 1990 年至 1999 年间，59 例接受硬膜外（n = 59）和卵圆孔电极（n = 46）记录的癫痫患者。硬膜外和卵圆孔评估基于患者非侵入性 EEG-视频记录的结果，在非侵入性评估未能定位发作起始（75%，44 例）或 EEG 和影像学研究不一致（25%，15 例）的患者中进行，但允许对发作起始区进行可测试的假设。
大多数患者（n = 57）在 1990 年至 1994 年期间接受评估。仅 2 例患者在之后接受评估。硬膜外（n = 559）和卵圆孔（n = 83）电极记录的结果使我们能够对 31%（n = 18）的患者进行切除性癫痫手术，并排除 15%（n = 9）的患者进一步进行侵入性评估。在 49%（n = 29）的患者中，记录结果指导使用硬膜下和/或深部电极进行进一步的侵入性记录。仅对 3 名患者，电极记录未获得更多信息。暂时的发病率包括局部感染（硬膜外；n = 1）和面部疼痛（卵圆孔；n = 1），但没有发生永久性并发症。
近年来，硬膜外和卵圆孔电极几乎已被放弃，这很可能是由于神经影像学技术的改善，如 MRI、PET 和发作期 SPECT。然而，在选择的患者中，硬膜外电极和卵圆孔电极既可用作避免侵入性评估的措施，也可用于指导侵入性评估。
