Ruhr-Epileptology, Department of Neurology, University Hospital Knappschaftskrankenhaus, Bochum, Germany.
Epilepsia. 2012 Aug;53(8):1322-32. doi: 10.1111/j.1528-1167.2012.03545.x. Epub 2012 Jun 18.
In patients with pharmacoresistant focal-onset seizures, invasive presurgical workup can identify epilepsy surgery options when noninvasive workup has failed. Yet, the potential benefit must be balanced with procedure-related risks. This study examines risks associated with the implantation of subdural strip and grid, and intracerebral depth electrodes. Benefit of invasive monitoring is measured by seizure outcomes. Diagnostic procedures made possible by electrode implantation are described.
Retrospective evaluation of invasive workups in 242 epilepsy surgery candidates and additional 18 patients with primary brain tumors implanted for mapping only. Complications are scaled in five grades of severity. A regression analysis identifies risk factors for complications. Outcome is classified according to Engel's classification.
Complications of any type were documented in 23% of patients, and complications requiring surgical revision in 9%. We did not find permanent morbidity or mortality. Major risk factor for complications was the implantation of grids and the implantation of electrode assemblies comprising strip and grid electrodes. Depth electrodes were significantly correlated with a lower risk. Tumors were not correlated with higher complication rates. Chronic invasive monitoring of 3-40 days allowed seizure detection in 99.2% of patients with epilepsy and additional extensive mapping procedures. Patients with epilepsy with follow-up >24 months (n = 165) had an Engel class 1a outcome in 49.7% if epilepsy surgery was performed, but only 6.3% when surgery was rejected.
The benefit of chronic invasive workup outweighs its risks, but complexity of implantations should be kept to a minimum.
在药物难治性局灶性发作性癫痫患者中，当非侵入性检查失败时，侵入性术前检查可确定癫痫手术的选择。然而，潜在的益处必须与相关程序的风险相平衡。本研究检查了植入硬膜下条带和网格以及脑内深部电极相关的风险。通过癫痫发作的结果来衡量侵入性监测的益处。还描述了通过电极植入实现的诊断程序。
回顾性评估了 242 例癫痫手术候选者和另外 18 例仅用于定位的原发性脑肿瘤患者的侵入性检查。并发症按严重程度分为五个等级。回归分析确定了并发症的危险因素。根据恩格尔分类法对结果进行分类。
任何类型的并发症在 23%的患者中均有记录，需要手术修正的并发症在 9%。我们没有发现永久性的发病率或死亡率。并发症的主要危险因素是网格的植入和包含条带和网格电极的电极组件的植入。深部电极与较低的风险显著相关。肿瘤与更高的并发症发生率无关。3-40 天的慢性侵入性监测使 99.2%的癫痫患者能够检测到癫痫发作，并进行了额外的广泛映射程序。在接受随访>24 个月的癫痫患者（n=165）中，如果进行癫痫手术，有 49.7%的患者术后达到恩格尔 1a 级，但如果手术被拒绝，仅有 6.3%的患者术后达到恩格尔 1a 级。
慢性侵入性检查的益处大于其风险，但植入物的复杂性应尽量降低。
