Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio 44118, USA.
Epilepsia. 2013 Feb;54(2):323-30. doi: 10.1111/j.1528-1167.2012.03672.x. Epub 2012 Sep 27.
Stereo-electroencephalography (SEEG) enables precise recordings from deep cortical structures, multiple noncontiguous lobes, as well as bilateral explorations while avoiding large craniotomies. Despite a long reported successful record, its application in the United States has not been widely adopted. We report on our initial experience with the SEEG methodology in the extraoperative mapping of refractory focal epilepsy in patients who were not considered optimal surgical candidates for other methods of invasive monitoring. We focused on the applied surgical technique and its utility and efficacy in this subgroup of patients.
Between March 2009 and May 2011, 100 patients with the diagnosis of medically refractory focal epilepsy who were not considered optimal candidates for subdural grids and strips placement underwent SEEG implantation at Cleveland Clinic Epilepsy Center. Demographics, noninvasive clinical data, number and location of implanted electrodes, electrophysiologic localization of the epileptic zone, complications, and short-term seizure outcome after resection were prospectively collected and analyzed.
Mean age was 32 years (range 5-68 years); 54 were male and 46 female. The mean follow-up after resection was 15 months. In total, 1,310 electrodes were implanted. Analyses of the SEEG recordings resulted in the electrographic localization of the epileptogenic focus in 96 patients. In the group of 75 patients who underwent resection, only 53 had at least 12 months follow-up. From this group, 33 patients (62.3%) were seizure-free at the end of the follow-up period. The presence of abnormal pathologic finding was strongly associated with postoperative seizure control (p = 0.005). The risk of hemorrhagic complications per electrode was 0.2%.
In patients who are not considered to be ideal candidates for subdural grids and strips implantation, the SEEG methodology is a safe, useful and reliable alternative option for invasive monitoring in patients with refractory focal epilepsy, providing an additional mean for seizure localization and control in a "difficult to localize" subgroup of patients.
立体脑电图（SEEG）能够精确记录来自深部皮质结构、多个非连续脑叶以及双侧的探索，同时避免大的开颅手术。尽管有长期报告的成功记录，但它在美国的应用尚未得到广泛采用。我们报告了我们在对不适合其他侵入性监测方法的难治性局灶性癫痫患者进行手术前定位中的 SEEG 方法的初步经验。我们专注于该手术技术的应用及其在这组患者中的实用性和有效性。
在 2009 年 3 月至 2011 年 5 月期间，克利夫兰诊所癫痫中心对 100 名被诊断为药物难治性局灶性癫痫且不适合放置硬膜下网格和条带的患者进行了 SEEG 植入。前瞻性收集和分析了人口统计学资料、非侵入性临床数据、植入电极的数量和位置、癫痫区的电生理定位、并发症以及切除术后的短期癫痫发作结果。
平均年龄为 32 岁（范围 5-68 岁）；54 名男性，46 名女性。切除术后的平均随访时间为 15 个月。共植入 1310 个电极。对 SEEG 记录的分析导致在 96 名患者中定位了致痫灶。在接受切除手术的 75 名患者中，只有 53 名患者的随访时间至少为 12 个月。在这一组中，33 名患者（62.3%）在随访期末无癫痫发作。存在异常病理发现与术后癫痫控制密切相关（p = 0.005）。每个电极发生出血性并发症的风险为 0.2%。
在不适合放置硬膜下网格和条带的患者中，SEEG 方法是一种安全、有用且可靠的替代侵入性监测方法，为难治性局灶性癫痫患者提供了另一种额外的癫痫定位和控制方法，为“难以定位”的患者提供了一种辅助手段。
