Massachusetts General Hospital, Harvard Medical School, 50 Blossom Street, Thier 429, Boston, MA 02114, USA.
Neurosurg Clin N Am. 2020 Jul;31(3):471-479. doi: 10.1016/j.nec.2020.03.014.
The need to emphasize the network concept arises from the fact that the traditional surgical philosophy in American epilepsy centers has prioritized an electrical-anatomic, focus-oriented approach. In contrast, the stereoelectroencephalography philosophy focuses on using electrophysiology to determine the regions of cortex generating the clinical manifestation of the seizure. Viewing epilepsy surgery as network surgery enables optimal consideration of decisions related to the need for and method of intracranial monitoring, potential role of subcortical structures in seizure organization and propagation, upfront use of combinatorial therapies to prevent seizure emergence from the network, and use of neuromodulation in novel epilepsy indications.
强调网络概念的必要性源于这样一个事实，即美国癫痫中心的传统外科理念优先考虑电-解剖学、以焦点为导向的方法。相比之下，立体脑电图的理念则侧重于利用电生理学来确定产生癫痫发作临床表现的皮质区域。将癫痫手术视为网络手术，可以使与颅内监测的必要性和方法、皮质下结构在癫痫发作组织和传播中的潜在作用、组合治疗以预防网络中癫痫发作的出现、以及在新的癫痫适应症中使用神经调节相关的决策得到最佳考虑。
