癫痫手术前的颅内检查

Presurgical intracranial investigations in epilepsy surgery.

作者信息

Chauvel Patrick, Gonzalez-Martinez Jorge, Bulacio Juan

机构信息

Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States.

Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States.

出版信息

Handb Clin Neurol. 2019;161:45-71. doi: 10.1016/B978-0-444-64142-7.00040-0.

Abstract

Identification and localization of the "epileptogenic process" in the brain of patients with drug-resistant epilepsy for surgical cure is the goal of presurgical investigations. Intracranial recordings are required when conflicting data between seizure clinical semiology and EEG prevent precise localization within one hemisphere or lateralization, when a visible lesion on MRI seems unrelated to the electroclinical data, or in MRI-negative cases. Two methods are currently used. The objective of the subdural grid electrocorticography with or without depth electrodes (SDG/DE) is the best possible identification of the area of onset of spontaneous seizures and localization of the eloquent cortex. The objective of stereoelectroencephalography (SEEG) is to define the epileptogenic zone (configured as a network) and its relation to an unmasked lesion. Two-dimensional (SDG) and three-dimensional (SEEG) brain sampling dictate different strategies for noninvasive presurgical phase I goals as well as for data analysis. SEEG must resolve several potential localization hypotheses in a manner that cannot be achieved with SDG. SDG operates through brain surface coverage, unlike SEEG, which samples networks. SDG estimates the extent of cortical resection through a lobar or sublobar localization of ictal onset and constraints from functional mapping. SEEG defines a tailored resection according to the results of anatomo-electro-clinical correlations in stereotaxic space that will guide the ablation of the epileptogenic zone. SEEG is currently expanding faster than SDG. The prerequisites (especially in the preimplantation hypothetical strategy) and technical tools (especially stimulation and functional mapping) in the two methods are very different. This chapter presents a comparative review of the rationale, indications, electrode implantation strategies, interpretation, and surgical decision making of these two approaches of presurgical evaluation for epilepsy surgery.

摘要

识别和定位耐药性癫痫患者大脑中的“致痫过程”以进行手术治愈是术前检查的目标。当癫痫发作临床症状学和脑电图之间的数据相互矛盾,无法在一个半球内精确定位或进行侧别判断时,当MRI上可见的病变似乎与电临床数据无关时,或者在MRI阴性的病例中,需要进行颅内记录。目前使用两种方法。硬膜下网格脑电图(有或无深部电极,SDG/DE)的目的是尽可能准确地识别自发癫痫发作的起始区域并定位明确的皮层。立体脑电图(SEEG)的目的是定义致痫区(构成为一个网络)及其与未掩盖病变的关系。二维(SDG)和三维(SEEG)脑采样决定了非侵入性术前I期目标以及数据分析的不同策略。SEEG必须以SDG无法实现的方式解决几个潜在的定位假设。与对网络进行采样的SEEG不同,SDG通过覆盖脑表面来操作。SDG通过发作起始的叶或亚叶定位以及功能图谱的限制来估计皮层切除的范围。SEEG根据立体定向空间中的解剖-电-临床相关性结果定义定制的切除范围,这将指导致痫区的切除。目前SEEG的发展速度比SDG快。这两种方法的先决条件(特别是在植入前的假设策略中)和技术工具(特别是刺激和功能图谱)非常不同。本章对癫痫手术术前评估的这两种方法的原理、适应症、电极植入策略、解读和手术决策进行了比较性综述。

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