Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University, Frankfurt am Main, Germany.
Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University, Frankfurt am Main, Germany.
Epilepsy Behav. 2019 Feb;91:30-37. doi: 10.1016/j.yebeh.2018.05.012. Epub 2018 Jun 13.
Stereoelectroencephalography (sEEG) is a diagnostic procedure for patients with refractory focal epilepsies that is performed to localize and define the epileptogenic zone. In contrast to grid electrodes, sEEG electrodes are implanted using minimal invasive operation techniques without large craniotomies. Previous studies provided good evidence that sEEG implantation is a safe and effective procedure; however, complications in asymptomatic patients after explantation may be underreported. The aim of this analysis was to systematically analyze clinical and imaging data following implantation and explantation.
We analyzed 18 consecutive patients (mean age: 30.5 years, range: 12-46; 61% female) undergoing invasive presurgical video-EEG monitoring via sEEG electrodes (n = 167 implanted electrodes) over a period of 2.5 years with robot-assisted implantation. There were no neurological deficits reported after implantation or explantation in any of the enrolled patients. Postimplantation imaging showed a minimal subclinical subarachnoid hemorrhage in one patient and further workup revealed a previously unknown factor VII deficiency. No injuries or status epilepticus occurred during video-EEG monitoring. In one patient, a seizure-related asymptomatic cross break of two fixation screws was found and led to revision surgery. Unspecific symptoms like headaches or low-grade fever were present in 10 of 18 (56%) patients during the first days of video-EEG monitoring and were transient. Postexplantation imaging showed asymptomatic and small bleedings close to four electrodes (2.8%).
Overall, sEEG is a safe and well-tolerated procedure. Systematic imaging after implantation and explantation helps to identify clinically silent complications of sEEG. In the literature, complication rates of up to 4.4% in sEEG and in 49.9% of subdural EEG are reported; however, systematic imaging after explantation was not performed throughout the studies, which may have led to underreporting of associated complications.
立体脑电图（sEEG）是一种用于治疗耐药性局灶性癫痫的诊断程序，用于定位和定义致痫区。与栅格电极不同，sEEG 电极使用微创操作技术植入，无需进行大的开颅手术。先前的研究充分证明了 sEEG 植入是一种安全有效的程序；然而，无症状患者在取出后可能会出现并发症，但这些并发症可能报告不足。本分析的目的是系统地分析植入和取出后的临床和影像学数据。
我们分析了 18 例连续患者（平均年龄：30.5 岁，范围：12-46；61%为女性），他们在 2.5 年内接受了机器人辅助植入的立体脑电图（sEEG）电极（n=167 个植入电极）的侵入性术前视频脑电图监测。在任何入组患者中，植入或取出后均未报告神经功能缺损。植入后的影像学检查显示一名患者存在微小的亚临床蛛网膜下腔出血，进一步检查发现先前未知的因子 VII 缺乏症。在视频脑电图监测期间没有发生损伤或癫痫持续状态。在一名患者中，发现与癫痫发作相关的无症状固定螺钉交叉断裂，导致了翻修手术。在 18 例患者中有 10 例（56%）在视频脑电图监测的最初几天出现了非特异性症状，如头痛或低热，这些症状都是短暂的。取出后的影像学检查显示四个电极附近有无症状和小的出血（2.8%）。
总的来说，sEEG 是一种安全且耐受良好的程序。植入和取出后的系统影像学检查有助于识别 sEEG 的临床无症状并发症。文献中报道 sEEG 的并发症发生率高达 4.4%，而硬脑膜下脑电图的并发症发生率为 49.9%；然而，整个研究过程中并未进行系统的影像学检查，这可能导致相关并发症的报告不足。
