Kim Hyunmi, Lee Catherine, Knowlton Robert, Rozzelle Curtis, Blount Jeffrey P
Department of Pediatrics, Division of Pediatric Neurology, University of Alabama at Birmingham, Alabama 35233, USA.
J Neurosurg Pediatr. 2011 Jul;8(1):49-56. doi: 10.3171/2011.4.PEDS10519.
Depth electrodes provide a better sampling of sulci and regions of cortex that lie tangential to the plane of subdural electrodes. The aim of this study was to evaluate the utility of supplemental depth electrodes in the surgical treatment of pediatric patients with neocortical epilepsy.
Cases involving 12 consecutive pediatric patients (mean age [SD] 10.9 ± 4.4 years) were reviewed. Focal resective surgery (in 9 cases) or functional hemispherectomy (in 3 cases) was performed after intracranial monitoring. The mean total number of electrodes was 118 ± 29; the mean numbers of grid, strip, and depth electrodes were 95 ± 27, 10 ± 6, and 13 ± 5, respectively The most common pathological condition was focal cortical dysplasia.
In 4 cases, depth electrodes demonstrated the ictal onset zone in an area not easily accessible by grids or strips (in the basal temporal region in 3 cases and the upper opercular region in 1 case). In 3 of these 4 cases, the ictal onset zone was defined exclusively by the depth electrodes. In each of these 3 cases, the surface electrodes (on grids or strips) demonstrated early propagation but not ictal onset. In 9 cases, the depth electrodes also demonstrated the early propagation zone. The information about the ictal onset zone and the early propagation zone helped to provide additional information that affected the extent (in 7 cases) or depth (in 3 cases) of the resection. The proportion of the electrodes involved in resection relative to the total number of implanted electrodes was low (mean ± SD, 0.26 ± 0.09). Nine patients (75.0%) became seizure free (Engel class IA outcome) after surgery (mean duration of follow-up 25.7 ± 4.29 months). There were no surgical complications related to intracranial electroencephalography monitoring.
Most patients (75.0%) became seizure free after extensive monitoring and more limited resection of seizure-onset regions. Supplemental depth electrodes contribute to improved outcome by providing information about the ictal onset zone that is not accessible by grid or strip electrodes in some cases. The supplemental depth electrodes conferred an extra dimension of depth to the analysis, which allowed for successful outcome with more limited resection.
深部电极能更好地采集脑沟以及与硬膜下电极平面相切的皮质区域的样本。本研究的目的是评估辅助深部电极在小儿新皮质癫痫手术治疗中的效用。
回顾了连续12例小儿患者（平均年龄[标准差]10.9±4.4岁）的病例。在颅内监测后进行了局灶性切除手术（9例）或功能性大脑半球切除术（3例）。电极总数平均为118±29；栅格电极、条形电极和深部电极的平均数分别为95±27、10±6和13±5。最常见的病理状况是局灶性皮质发育异常。
在4例病例中，深部电极在栅格电极或条形电极不易到达的区域（3例位于颞叶基底区域，1例位于额上回区域）显示了发作起始区。在这4例中的3例中，发作起始区完全由深部电极确定。在这3例中的每一例中，表面电极（在栅格或条形电极上）显示了早期传播但未显示发作起始。在9例病例中，深部电极也显示了早期传播区。关于发作起始区和早期传播区的信息有助于提供影响切除范围（7例）或深度（3例）的额外信息。参与切除的电极数量相对于植入电极总数的比例较低（平均±标准差，0.26±0.09）。9例患者（75.0%）术后无癫痫发作（Engel I A级结果）（平均随访时间25.7±4.29个月）。没有与颅内脑电图监测相关的手术并发症。
大多数患者（75.0%）在进行广泛监测并更有限地切除癫痫发作起始区域后无癫痫发作。辅助深部电极通过提供在某些情况下栅格电极或条形电极无法获取的发作起始区信息，有助于改善治疗结果。辅助深部电极赋予了分析额外的深度维度，使得在更有限的切除情况下仍能获得成功的治疗结果。
