Musolino A, Tournoux P, Missir O, Talairach J
INSERM, Unité de recherche sur l'épilepsie, Paris.
J Neuroradiol. 1990;17(2):67-102.
Stereotactic implantation of deep SEEG electrodes performed as a prelude to surgery in some patients with drug-resistant focal epilepsy requires previous "in vivo" identification and localization of the cortical and subcortical structures to be explored, visualized "semi-directly" "or directly" by neuroradiological imaging techniques. Stereoscopic stereotactic teleangiography is a safety factor in transcutaneous electrode implantation and biopsies, but it also localizes the cortical sulci in a "semi-direct" manner by identifying vascular segments deeply buried in this sulci, which constitute their lamina vascularis. Although RMI greatly contributes to the study of the pallium, visualizing fragments of sulci and gyri does not necessarily mean that these structures can be identified with certainty, notably on the convexity of the brain. To solve this problem, RMI sections are enlarged by a photographic process, then combined with the images obtained from neuroradiological stereotaxis by means of anatomical landmarks that are common to both types of documents, using the bicommissural reference systems, bicallosal l/nl or vascular segments. This enables the angiographic laminae vascularis, which define the sulci in a "semi-direct" manner, to be used a kind of "Ariadne's clew" to identify cortical structures on RMI sections. In percutaneous stereotactic electrode implantation, the choice of the trajectories results from a compromise between the need to reach the desired anatomical structures, identified and localized within the stereotactic space, and the necessity to avoid the blood vessels displayed by stereoangiography. In some cases, the accuracy of anatomical definition can be verified during the SEEG study and/or by the evoked potential technique. Once the electrodes have been removed, their traces can be identified in a control RMI examination which constitutes a further verification.
对于一些药物难治性局灶性癫痫患者，在手术前进行立体定向植入深部SEEG电极，需要事先通过神经放射成像技术“半直接”或“直接”对要探测的皮质和皮质下结构进行“活体”识别和定位。立体定向血管造影是经皮电极植入和活检的一个安全因素，但它也通过识别深埋在脑沟中的血管段以“半直接”方式定位皮质脑沟，这些血管段构成了它们的血管层。尽管磁共振成像（RMI）对大脑皮质的研究有很大帮助，但可视化脑沟和脑回的片段并不一定意味着这些结构能够被确切识别，特别是在脑凸面。为了解决这个问题，通过摄影方法放大RMI切片，然后借助两种文档共有的解剖标志，使用双连合参考系统、双胼胝体l/nl或血管段，将其与神经放射立体定向获得的图像相结合。这使得以“半直接”方式定义脑沟的血管造影血管层能够用作一种“阿里阿德涅之线”来识别RMI切片上的皮质结构。在经皮立体定向电极植入中，轨迹的选择是在到达立体定向空间内已识别和定位的所需解剖结构的需求与避免立体血管造影显示的血管的必要性之间进行权衡的结果。在某些情况下，解剖定义的准确性可以在SEEG研究期间和/或通过诱发电位技术进行验证。一旦电极被移除，它们的痕迹可以在对照RMI检查中识别，这构成了进一步的验证。
