Department of Neurosurgery, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan.
Department of Neurosurgery, Chang Gung Memorial Hospital, 5, Fu-Shing Street, 333 Kweishan, Taoyuan, Taiwan.
Acta Neurochir (Wien). 2020 Feb;162(2):261-269. doi: 10.1007/s00701-019-04137-3. Epub 2019 Nov 28.
Electrical cortical stimulation is shown effective in treating patients with drug-resistant epilepsy. We demonstrated how detailed procedures of pre- and intra-operative planning of cortical stimulation implantation may influence the results of seizure reduction rate.
To confirm the precision of subdural grids covering the epileptogenic foci in the eloquent regions, pre- and intra-operative video-electroencephalography (VEEG) were performed in patients with drug-resistant epilepsy during a 4-day 24-h monitoring. The localization of the grid was determined via 3D reconstruction imaging of subdural electrodes co-registered onto the patient's cortex. A final quadripolar lead in cyclic stimulation mode was then placed and secured on the target cortex area. Post-operative 3D CT ensured the accurate location of stimulation lead without any misplacement. Bipolar cyclic stimulation and post-implantation VEEG were performed for 7 days. Patients were discharged and followed up regularly for parameters adjustment and recording of seizure outcomes.
Eight patients received chronic cortical stimulation implantations between February 2003 and December 2017. The mean age of these patients was 21.1 years old and the average post-operative follow-up was 77.3 months. Comparisons of their seizure frequency at baseline and during the postoperative period revealed a mean reduction in seizures of 60.4% at the first year and 65.6% at the second year.
Pre-surgical planning enhanced the accuracy of electrode placement and led to a favorable seizure reduction rate. Our report confirms that electrical cortical stimulation with detailed implantation procedures is safe and effective for patients with drug-resistant epilepsy originating from eloquent cortex.
电皮质刺激已被证明对治疗耐药性癫痫患者有效。我们展示了皮质刺激植入术的术前和术中详细规划过程如何影响癫痫发作减少率的结果。
为了确认在语言相关区域覆盖致痫灶的硬膜下网格的精确性，在 4 天 24 小时监测期间对耐药性癫痫患者进行了术前和术中视频脑电图（VEEG）。通过将硬膜下电极与患者皮质配准的 3D 重建图像确定网格的定位。然后将最终的四极导联以循环刺激模式放置并固定在目标皮质区域上。术后 3D CT 确保了刺激导联的准确位置，没有任何错位。进行双极循环刺激和术后 VEEG 监测 7 天。患者出院并定期随访，以调整参数并记录癫痫发作结果。
2003 年 2 月至 2017 年 12 月期间，8 例患者接受了慢性皮质刺激植入。这些患者的平均年龄为 21.1 岁，平均术后随访时间为 77.3 个月。比较他们在基线和术后期间的癫痫发作频率，发现第一年的平均癫痫发作减少了 60.4%，第二年的平均癫痫发作减少了 65.6%。
术前规划提高了电极放置的准确性，并导致了有利的癫痫发作减少率。我们的报告证实，对于起源于语言相关皮质的耐药性癫痫患者，用电皮质刺激进行详细的植入程序是安全有效的。
