Lee Changik, Jeong Woorim, Chung Chun Kee
Department of Neurosurgery, Seoul St. Mary's Hospital, Seoul, Korea.
Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.
J Epilepsy Res. 2019 Dec 31;9(2):126-133. doi: 10.14581/jer.19015. eCollection 2019 Dec.
Although some surgeons utilize interictal spikes recorded via electrocorticography (ECoG) when planning extensive peritumoral resection in patients with tumor-related epilepsy, the association between interictal spikes and epileptogenesis has not been fully described. We investigated whether the resection of interictal spikes recorded by ECoG is associated with more favorable surgical outcomes in tumor-related epilepsy.
Of 132 patients who underwent epilepsy surgery for tumor-related epilepsy from 2006 to 2013, seven patients who underwent extraoperative ECoG were included in this study. In each patient, ECoG interictal spike sources were localized using standardized low-resolution brain electromagnetic tomography and were co-registered into a reconstructed brain model. Correspondence to the resection volume was estimated by calculating the percentage of interictal spike sources in the resection volume.
All patients achieved gross total resection without oncological recurrence. Five patients achieved favorable surgical outcomes, whereas the surgical outcomes of two patients were unfavorable. Correspondence rates to the resection volume in the favorable and unfavorable surgical outcome groups were 44.6%±27.8% and 43.5%±22.8%, respectively (=0.96). All patients had interictal spike source clusters outside the resection volume regardless of seizure outcome.
In these cases of tumor-related epilepsy, the extent of the resection of ECoG interictal spikes was not associated with postoperative seizure outcomes. Furthermore, the presence of interictal spike sources outside of the resection area was not related to seizure outcomes. Instead, concentrating more on the complete removal of the brain tumor appears to be a rational approach.
尽管一些外科医生在为肿瘤相关性癫痫患者规划广泛的瘤周切除术时会利用通过皮质脑电图（ECoG）记录的发作间期棘波，但发作间期棘波与癫痫发生之间的关联尚未得到充分描述。我们研究了切除由ECoG记录的发作间期棘波是否与肿瘤相关性癫痫更有利的手术结果相关。
在2006年至2013年接受癫痫手术治疗肿瘤相关性癫痫的132例患者中，本研究纳入了7例行术中ECoG检查的患者。在每位患者中，使用标准化低分辨率脑电磁断层扫描对ECoG发作间期棘波源进行定位，并将其共同注册到重建的脑模型中。通过计算切除体积中发作间期棘波源的百分比来估计与切除体积的对应关系。
所有患者均实现了肿瘤全切且无肿瘤复发。5例患者取得了良好的手术效果，而2例患者的手术效果不佳。手术效果良好组和不佳组与切除体积的对应率分别为44.6%±27.8%和43.5%±22.8%（=0.96）。无论癫痫发作结果如何，所有患者在切除体积外均有发作间期棘波源簇。
在这些肿瘤相关性癫痫病例中，切除ECoG发作间期棘波的范围与术后癫痫发作结果无关。此外，切除区域外存在发作间期棘波源与癫痫发作结果无关。相反，更专注于脑肿瘤的完整切除似乎是一种合理的方法。
