Department of Neurosurgery, Stanford University School of Medicine, United States of America.
Department of Neurology, Stanford University School of Medicine, United States of America; Division of Pediatric Neurology, Lucile Packard Children's Hospital Stanford, United States of America.
Epilepsy Behav. 2020 Mar;104(Pt A):106905. doi: 10.1016/j.yebeh.2020.106905. Epub 2020 Feb 3.
For patients with medically refractory epilepsy, intracranial electrode monitoring can help identify epileptogenic foci. Despite the increasing utilization of stereoelectroencephalography (SEEG), the relative risks or benefits associated with the technique when compared with the traditional subdural electrode monitoring (SDE) remain unclear, especially in the pediatric population. Our aim was to compare the outcomes of pediatric patients who received intracranial monitoring with SEEG or SDE (grids and strips).
We retrospectively studied 38 consecutive pediatric intracranial electrode monitoring cases performed at our institution from 2014 to 2017. Medical/surgical history and operative/postoperative records were reviewed. We also compared direct inpatient hospital costs associated with the two procedures.
Stereoelectroencephalography and SDE cohorts both showed high likelihood of identifying epileptogenic zones (SEEG: 90.9%, SDE: 87.5%). Compared with SDE, SEEG patients had a significantly shorter operative time (118.7 versus 233.4 min, P < .001) and length of stay (6.2 versus 12.3 days, P < .001), including days spent in the intensive care unit (ICU; 1.4 versus 5.4 days, P < .001). Stereoelectroencephalography patients tended to report lower pain scores and used significantly less narcotic pain medications (54.2 versus 197.3 mg morphine equivalents, P = .005). No complications were observed. Stereoelectroencephalography and SDE cohorts had comparable inpatient hospital costs (P = .47).
In comparison with subdural electrode placement, SEEG results in a similarly favorable clinical outcome, but with reduced operative time, decreased narcotic usage, and superior pain control without requiring significantly higher costs. The potential for an improved postoperative intracranial electrode monitoring experience makes SEEG especially suitable for pediatric patients.
对于药物难治性癫痫患者，颅内电极监测有助于确定致痫灶。尽管立体脑电图（SEEG）的应用越来越广泛，但与传统的硬膜下电极监测（SDE）相比，该技术的相对风险或益处仍不清楚，尤其是在儿科人群中。我们的目的是比较在我们机构进行的颅内监测的儿童患者的结果，这些患者接受了立体脑电图或 SDE（网格和条带）监测。
我们回顾性研究了 2014 年至 2017 年在我们机构进行的 38 例连续的儿童颅内电极监测病例。回顾了医疗/手术史和手术/术后记录。我们还比较了两种手术相关的直接住院费用。
SEEG 和 SDE 两组均高度可能确定致痫区（SEEG：90.9%，SDE：87.5%）。与 SDE 相比，SEEG 患者的手术时间（118.7 与 233.4 分钟，P<0.001）和住院时间（6.2 与 12.3 天，P<0.001）明显缩短，包括在重症监护病房（ICU）度过的天数（1.4 与 5.4 天，P<0.001）。SEEG 患者报告的疼痛评分较低，使用的阿片类止痛药明显较少（54.2 与 197.3 毫克吗啡当量，P=0.005）。未观察到并发症。SEEG 和 SDE 两组的住院费用相当（P=0.47）。
与硬膜下电极放置相比，SEEG 结果具有相似的临床疗效，但手术时间更短，阿片类药物使用减少，疼痛控制更好，且不需要显著增加成本。SEEG 具有改善术后颅内电极监测体验的潜力，特别适合儿科患者。
