Enatsu Rei, Bulacio Juan, Najm Imad, Wyllie Elaine, So Norman K, Nair Dileep R, Foldvary-Schaefer Nancy, Bingaman William, Gonzalez-Martinez Jorge
Epilepsy Center, Desk S60, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA; Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, OH, USA.
Epilepsy Center, Desk S60, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA; Department of Neurology, Cleveland Clinic Foundation, Cleveland, OH, USA.
J Clin Neurosci. 2014 Aug;21(8):1441-5. doi: 10.1016/j.jocn.2013.12.014. Epub 2014 Jan 24.
Stereo-electroencephalography (SEEG) has advantages for exploring deeper epileptic foci. Nevertheless, SEEG can only sample isolated cortical areas and its spatial limitation, with the inability to record contiguous cortical regions, may cause difficulties in interpretation. In light of these limitations, the authors describe the hybrid technique of SEEG and subdural strip electrode placement. The hybrid technique was used for a presurgical evaluation in four patients with intractable epilepsy. Initially, the depth electrodes were inserted with a robotic stereotactic system. Thereafter, a skin incision and a small craniectomy were performed at the entry point of the strip electrode trajectory. The dura was opened and, under live fluoroscopic guidance, strip electrodes were slid into the subdural space. In these patients, the additional subdural strip electrodes provided (1) information regarding the precise description of seizure spread in the cortical surface adjacent to the subdural space, (2) identification of epileptogenic zones located near the crown, (3) more precise definition of functional cortex and (4) a better delineation of the interface between epileptogenic zones and functional cortex. This hybrid technique provides additional data compared to either technique alone, offering superior understanding of the dynamics of the epileptic activity and its interaction with functional cortical areas.
立体定向脑电图（SEEG）在探索更深层的癫痫病灶方面具有优势。然而，SEEG只能对孤立的皮质区域进行采样，其空间局限性在于无法记录连续的皮质区域，这可能会导致解释困难。鉴于这些局限性，作者描述了SEEG与硬膜下条形电极放置的联合技术。该联合技术用于4例难治性癫痫患者的术前评估。最初，使用机器人立体定向系统插入深部电极。此后，在条形电极轨迹的入口点进行皮肤切口和小的颅骨切除术。打开硬脑膜，在实时荧光透视引导下，将条形电极滑入硬膜下间隙。在这些患者中，额外的硬膜下条形电极提供了：（1）关于癫痫发作在硬膜下间隙相邻皮质表面扩散的精确描述信息；（2）识别位于顶部附近的致痫区；（3）更精确地界定功能皮质；（4）更好地描绘致痫区与功能皮质之间的界面。与单独使用任何一种技术相比，这种联合技术提供了更多的数据，能更好地理解癫痫活动的动态变化及其与功能皮质区域的相互作用。
