Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai 200040, China.
Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai 200040, China; Department of Neurosurgery, Jing'an branch of Huashan Hospital, Fudan University, Shanghai 200040, China.
Seizure. 2018 Jul;59:126-131. doi: 10.1016/j.seizure.2018.05.009. Epub 2018 May 19.
High-density electroencephalographic source imaging (HD-ESI) has emerged as a useful tool for pre-surgical epilepsy workup. However, it is not routinely used in clinical evaluations due to several factors, one of which is the challenge associated with creating anatomically accurate head models. Reasonable solutions now exist and the present study aims to evaluate the use of these highly resolved individual head models in pre-surgical epilepsy evaluation.
Nine patients with intractable epilepsy who were candidates for resective epilepsy surgeries participated in the study. For each patient, 256-channel electroencephalography data were acquired along with individual structural MRI data that was used to construct individual finite difference models (iFDM). Accuracy of HD-ESI based on iFDM (HD-ESI-iFDM) was evaluated using multiple criteria, including concordance with intracranial electroencephalography (icEEG) and location of surgical resection. Performance of HD-ESI-iFDM was also compared against MRI and positron emission tomography (PET) results.
In all but one patient resective surgeries resulted in seizure-free outcome. Source locations derived from HD-ESI-iFDM demonstrated concordance with surgical resection and with icEEG data, when available. The HD-ESI-iFDM also contributed to the planning of intracranial electrodes implantation. Compared to MRI or PET, HD-ESI-iFDM provided more accurate localization of the epileptogenic zone.
When acquired with high-density sensor arrays and source imaging is performed with anatomically accurate head models, electroencephalography can contribute meaningfully to epilepsy pre-surgical workup for localization of the epileptogenic zone. Now that both high-density electroencephalography and individualized FDM models can be routinely obtained, it can be incorporated as part of clinical practice.
高密度脑电图源成像（HD-ESI）已成为术前癫痫评估的有用工具。然而，由于多种因素，它并未在临床评估中常规使用，其中之一是创建解剖准确的头部模型所面临的挑战。现在已经有合理的解决方案，本研究旨在评估在术前癫痫评估中使用这些高分辨率个体头部模型。
9 名患有难治性癫痫且适合进行切除术的癫痫患者参与了本研究。对于每位患者，均采集 256 通道脑电图数据以及个体结构 MRI 数据，用于构建个体有限差分模型（iFDM）。使用多种标准评估基于 iFDM 的 HD-ESI（HD-ESI-iFDM）的准确性，包括与颅内脑电图（icEEG）的一致性和手术切除部位。还比较了 HD-ESI-iFDM 的性能与 MRI 和正电子发射断层扫描（PET）结果。
除了一名患者外，所有患者的切除手术均导致无癫痫发作。当可获得时，源自 HD-ESI-iFDM 的源定位与手术切除和 icEEG 数据一致。HD-ESI-iFDM 还有助于规划颅内电极植入。与 MRI 或 PET 相比，HD-ESI-iFDM 更准确地定位了致痫区。
当使用高密度传感器阵列采集并使用解剖准确的头部模型进行源成像时，脑电图可以为致痫区的定位提供有意义的术前癫痫评估。现在既可以常规获得高密度脑电图，也可以获得个体化的 FDM 模型，因此可以将其纳入临床实践。
