Chan Alvin Y, Tran Diem Kieu, Paff Michelle R, Urgun Kamran, Hsu Frank P K, Vadera Sumeet
Comprehensive Epilepsy Program, Department of Neurological Surgery, University of California, Irvine, California.
Oper Neurosurg (Hagerstown). 2020 Jul 1;19(1):19-24. doi: 10.1093/ons/opz360.
Responsive neurostimulation (RNS) is a closed-loop neurostimulation modality for treating intractable epilepsy in patients who are not candidates for resection. In the past, implantation of depth electrodes was done through a transoccipital approach that transverses the hippocampus. There have been no descriptions of orthogonal approaches to RNS electrode placement.
To describe our initial experience with placing RNS depth electrodes using an orthogonal approach to target the short axis of the mesial temporal lobe.
Presurgical work-up included magnetic resonance imaging, video electroencephalography, and neuropsychological testing. During the procedure, patients were placed with their heads in a neutral position. Electrodes were placed via stereotactic robotic assistance using a unilateral orthogonal approach targeting the amygdala or hippocampus. Patients who underwent RNS electrode implantation via orthogonal approach were identified. Multiple variables were collected, including age, disease onset, complications, follow-up, semiology, and seizure reduction.
There were 8 patients who underwent RNS electrode placement with orthogonal approach. The mean age and follow-up were 44.8 and 1.2 yr, respectively. There were 4 patients with at least 1-yr follow-up. Of them, 1 was seizure free and 2 experienced over 50% reduction in seizures. There were no complications associated with electrode implantation.
The initial experience using an orthogonal approach for depth electrode placement for RNS implantation was described. The potential advantages may include better safety, accuracy, and positioning in comparison to a transoccipital approach.
响应性神经刺激（RNS）是一种闭环神经刺激方式，用于治疗不适合进行切除手术的顽固性癫痫患者。过去，深度电极植入是通过经枕部入路进行的，该入路会横穿海马体。目前尚无关于RNS电极放置的正交入路的描述。
描述我们使用正交入路放置RNS深度电极以靶向颞叶内侧短轴的初步经验。
术前检查包括磁共振成像、视频脑电图和神经心理学测试。手术过程中，患者头部处于中立位置。电极通过立体定向机器人辅助，采用单侧正交入路靶向杏仁核或海马体进行放置。确定通过正交入路接受RNS电极植入的患者。收集多个变量，包括年龄、疾病发作、并发症、随访、症状学和癫痫发作减少情况。
有8例患者通过正交入路进行了RNS电极放置。平均年龄和随访时间分别为44.8岁和1.2年。有4例患者至少随访了1年。其中，1例无癫痫发作，2例癫痫发作减少超过50%。电极植入未出现并发症。
描述了使用正交入路进行RNS植入深度电极放置的初步经验。与经枕部入路相比，其潜在优势可能包括更好的安全性、准确性和定位。
