1Department of Neurosurgery,Montreal Neurological Institute and Hospital,McGill University,Montreal,Quebec,Canada.
Can J Neurol Sci. 2018 Jan;45(1):35-43. doi: 10.1017/cjn.2017.240.
Stereoelectroencephalography has been in regular use at the Montreal Neurological Institute since 1972. The technique has been in constant evolution to incorporate advances in materials, imaging, and robotics technology. MRI-compatible electrodes were introduced in 2007 and robotics in 2011. Here we report on the technique, safety, and advantages of our current method of stereoelectroencephalography implantation.
We retrospectively reviewed all patients who underwent stereoelectroencephalography by the senior author. Technical, clinical, and radiological complications, and postimplantation outcomes were analyzed. Only patients implanted with MRI-compatible electrodes were included to review MRI abnormalities with electrodes in situ.
A total of 53 patients were implanted with 550 electrodes (average=10.4 per patient), for an average duration of 14.6 days. There was no mortality, infection, or new neurologic deficit. Two patients had a superficial screw plunge without clinical consequence. Four patients demonstrated asymptomatic MRI abnormalities (7.54% per patient, or 0.72% per electrode). MRI with electrodes in situ was used for neuronavigation in all 29 who underwent resection and yielded a histopathological diagnosis of focal cortical dysplasia in 15 MRI-negative patients.
The technique of stereoelectroencephalography described here was associated with no clinical morbidity although not without technical complications or radiologic (MRI) abnormalities. We should therefore remain vigilant in refining the technique and minimizing the number of electrodes required to answer a well-developed hypothesis regarding the epileptogenic zone. The use of MRI-compatible electrodes allowed neuronavigation using the images with the electrodes in situ, which was useful to tailor the eventual definitive resection and in localizing MRI-negative lesions.
自 1972 年以来，立体脑电图一直在蒙特利尔神经学研究所常规使用。该技术一直在不断发展，以纳入材料、成像和机器人技术的进步。2007 年引入了与 MRI 兼容的电极，2011 年引入了机器人技术。在这里，我们报告我们目前立体脑电图植入技术的技术、安全性和优势。
我们回顾性地审查了所有由资深作者进行立体脑电图的患者。分析了技术、临床和影像学并发症以及植入后的结果。仅包括植入 MRI 兼容电极的患者，以审查原位电极的 MRI 异常。
共有 53 名患者植入了 550 个电极（平均每名患者 10.4 个），平均植入时间为 14.6 天。无死亡率、感染或新的神经功能缺损。两名患者出现了无症状的螺钉深度异常，但无临床后果。四名患者出现了无症状的 MRI 异常（每名患者 7.54%，或每根电极 0.72%）。所有 29 名接受切除术的患者均进行了原位电极 MRI，其中 15 名 MRI 阴性患者的病理诊断为局灶性皮质发育不良。
尽管并非没有技术并发症或影像学（MRI）异常，但这里描述的立体脑电图技术与临床发病率无关。因此，我们应该保持警惕，不断改进技术，尽量减少为回答有关致痫区的完善假说所需的电极数量。使用与 MRI 兼容的电极允许使用原位电极的图像进行神经导航，这对于定制最终的确定性切除术和定位 MRI 阴性病变非常有用。
