de Font-Réaulx Enrique, Lluch Javier Terrazo, López Ramón López, Bialik Paul Shkurovich, Corona Miguel Ángel Collado, López Luis Guillermo Díaz, Tirado Emilio Arch, Navarrete Ernesto Ramírez, Astiazarán Adalberto González
Departments of Neurosurgery, ABC Medical Center, Mexico.
Department of Neurorsurgery, La Raza UMAE, Social Security Mexican Institute, Mexico.
Surg Neurol Int. 2020 Feb 28;11:30. doi: 10.25259/SNI_549_2019. eCollection 2020.
In several epilepsy etiologies, the macroscopic appearance of the epileptogenic tissue is identical to the normal, which makes it hard to balance between how much cytoreduction or disconnection and brain tissue preservation must be done. A strategy to tackle this situation is by evaluating brain metabolism during surgery using infrared thermography mapping (IrTM).
In 12 epilepsy surgery cases that involved the temporal lobe, we correlated the IrTM, electrocorticography, and neuropathology results.
Irritative zones (IZ) had a lower temperature in comparison to the surrounding cortex with normal electric activity (difference in temperature (ΔT) from 1.2 to 7.1, mean 3.40°C standard deviation ± 1.61). The coldest zones correlated exactly with IZ in 9/10 cortical dysplasia (CD) cases. In case 3, the coldest area was at 1 cm away from the IZ. In 10/10 dysplasia cases (cases 1-4, 6-11), there was a radial heating pattern originating from the coldest cortical point. In 2/2 neoplasia cases, the temporal lobe cortical temperature was more homogeneous than in the CD cases, with no radial heating pattern, and there were no IZ detected. In case 8, we found the coldest IrTM recording in the hippocampus, which correlated to the maximal irritative activity recorded by strip electrodes. The ΔT is inversely proportional to epilepsy chronicity.
IrTM could be useful in detecting hypothermic IZ in CD cases. As the ΔT is inversely proportional to epilepsy chronicity, this variable could affect the metabolic thermic patterns of the human brain.
在几种癫痫病因中，致痫组织的宏观外观与正常组织相同，这使得在进行多少细胞消减或神经连接切断以及脑组织保留之间难以平衡。解决这种情况的一种策略是在手术期间使用红外热成像图谱（IrTM）评估脑代谢。
在12例涉及颞叶的癫痫手术病例中，我们将IrTM、皮质脑电图和神经病理学结果进行了关联。
与具有正常电活动的周围皮质相比，刺激区（IZ）温度较低（温度差（ΔT）为1.2至7.1，平均3.40°C，标准差±1.61）。在9/10的皮质发育异常（CD）病例中，最冷区域与IZ完全相关。在病例3中，最冷区域距离IZ 1厘米。在10/10的发育异常病例（病例1 - 4、6 - 11）中，存在从最冷皮质点开始的径向加热模式。在2/2的肿瘤病例中，颞叶皮质温度比CD病例更均匀，没有径向加热模式，且未检测到IZ。在病例8中，我们在海马体中发现了最冷的IrTM记录，这与条形电极记录的最大刺激活动相关。ΔT与癫痫病程呈反比。
IrTM可用于检测CD病例中的低温IZ。由于ΔT与癫痫病程呈反比，该变量可能会影响人脑的代谢热模式。
