Valentín A, Hernando-Quintana N, Moles-Herbera J, Jimenez-Jimenez D, Mourente S, Malik I, Selway R P, Alarcón G
Department of Basic and Clinical Neuroscience, King's College London, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), UK; Department of Clinical Neurophysiology, King's College Hospital NHS Trust, London, UK.
Department of Basic and Clinical Neuroscience, King's College London, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), UK.
Clin Neurophysiol. 2017 Mar;128(3):418-423. doi: 10.1016/j.clinph.2016.12.018. Epub 2016 Dec 29.
To study retrospectively the impact of electrode modality (subdural or depth electrodes) during presurgical assessment on surgical outcome after temporal lobectomy.
The study included 17 patients assessed with depth electrodes and 57 with bitemporal subdural strips.
MRI showed a larger proportion of bilateral pathology in patients undergoing depth recordings (29.41% versus 3.5%, p=0.00069). Among the operated patients, those undergoing depth electrode recordings showed better outcome at one year after surgery (11/12 versus 22/33; p=0.046). This difference disappears at longest follow up (10/12 versus 22/33; p=0.138). Moreover, the probability of undergoing surgery and having good outcome after assessment with intracranial recordings is higher for the depth electrode group at one-year follow up (11/17 versus 22/57; p=0.029) but statistical differences decrease to a trend for the longest follow up (10/17 versus 22/57; p=0.069). No other statistical differences were noted between subdural and depth electrodes. Depth electrodes showed lower complication rates than subdural electrodes.
Both depth and subdural electrodes are effective for presurgical assessment of temporal lobe epilepsy.
Assessment with depth electrodes is associated with slightly increased likelihood of surgery and marginally better surgical outcome at one year follow up which disappears for longer follow up periods. Initial assessment with depth electrodes would have avoided a second implantation in 15% of patients.
回顾性研究术前评估期间电极方式（硬膜下或深部电极）对颞叶切除术后手术结果的影响。
该研究纳入了17例使用深部电极进行评估的患者和57例使用双侧硬膜下条带电极的患者。
MRI显示，进行深部记录的患者双侧病变比例更高（29.41%对3.5%，p = 0.00069）。在接受手术的患者中，使用深部电极记录的患者术后一年的结果更好（11/12对22/33；p = 0.046）。在最长随访期时这种差异消失（10/12对22/33；p = 0.138）。此外，在一年随访时，深部电极组在颅内记录评估后接受手术并获得良好结果的概率更高（11/17对22/57；p = 0.029），但在最长随访期时统计差异降至趋势水平（10/17对22/57；p = 0.069）。硬膜下电极和深部电极之间未发现其他统计学差异。深部电极的并发症发生率低于硬膜下电极。
深部电极和硬膜下电极在颞叶癫痫的术前评估中均有效。
使用深部电极进行评估与手术可能性略有增加以及一年随访时手术结果略好相关，而在更长随访期时这种情况消失。对15%的患者进行深部电极初始评估可避免二次植入。
