Vivian L. Smith Department of Neurosurgery, McGovern Medical School at UT Health, Houston, Texas, USA.
Vivian L. Smith Department of Neurosurgery, McGovern Medical School at UT Health, Houston, Texas, USA; Texas Institute of Restorative Neurotechnologies, UT Health, Houston, Texas, USA.
World Neurosurg. 2020 Dec;144:e734-e742. doi: 10.1016/j.wneu.2020.09.063. Epub 2020 Sep 16.
Intracranial recordings are integral to evaluating patients with pharmacoresistant epilepsy whom noninvasive testing fails to localize seizure focus. Although stereo-electroencephalography is the preferred method of intracranial recordings in most centers, subdural electrode (SDE) implantation is necessary in selected cases.
To identify imaging correlates that predict SDE complications (extra-axial fluid collections [EFCs]), and determine if modifications that diminish stiffness of electrode sheets reduce complications.
A prospective epilepsy surgery database was used to identify adults undergoing craniotomy for SDE implantation over a 14-year period. EFCs and midline shift were measured via magnetic resonance imaging and computed tomography imaging. Correlation analyses and multivariable logistic regression explored associations between use of conformal arrays, serial order of patients, previous ipsilateral intracranial surgery, midline shift, number of SDEs, and neurologic complications.
A total of 111 consecutive patients (59 female) underwent 117 craniotomies (mean, 115 electrode contacts) for SDE implantation. There were 8 surgical complications, 3 in the first 17 (17.7%). and 5 (after electrode modifications) in a subsequent 100 craniotomies (5.0%). We noted an increase in electrode numbers implanted over time (P < 0.001) and decreased midline shift with conformal grids (ρ = - 0.32; P < 0.001). A multivariable regression showed that midline shift correlated with complications (odds ratio, 2.32; 95% confidence interval, 1.12-4.78; P = 0.023).
Hemorrhagic complications after SDE implantation are difficult to detect because of artifact from electrodes, but predictable by prominent midline shift (>4 mm). Risks inherent to SDE implantation may be minimized using conformal grids. With symptomatic EFCs, a single electrode cable exit site allows hematoma evacuation without terminating intracranial recordings.
颅内记录对于评估非侵入性测试无法定位癫痫发作焦点的耐药性癫痫患者至关重要。尽管立体脑电图是大多数中心首选的颅内记录方法，但在某些情况下需要植入硬膜下电极（SDE）。
确定预测 SDE 并发症（额外轴液体积聚[EFC]）的影像学相关性，并确定是否可以减少电极片刚度的修改来降低并发症发生率。
使用前瞻性癫痫手术数据库，在 14 年期间确定接受 SDE 植入开颅手术的成年人。通过磁共振成像和计算机断层扫描测量 EFC 和中线移位。相关性分析和多变量逻辑回归探讨了使用共形电极、患者连续顺序、同侧颅内手术史、中线移位、SDE 数量和神经并发症之间的关联。
共有 111 例连续患者（59 例女性）接受了 117 次 SDE 植入开颅手术（平均 115 个电极接触）。有 8 例手术并发症，前 17 例中有 3 例（17.7%），随后 100 例开颅手术中有 5 例（电极修改后）（5.0%）。我们注意到随着时间的推移植入的电极数量增加（P < 0.001），并且共形网格降低了中线移位（ρ=-0.32；P < 0.001）。多变量回归显示中线移位与并发症相关（优势比，2.32；95%置信区间，1.12-4.78；P=0.023）。
由于电极的伪影，SDE 植入后出血性并发症难以检测，但可以通过明显的中线移位（>4 毫米）预测。使用共形网格可以最大限度地降低 SDE 植入的固有风险。对于有症状的 EFC，单个电极电缆出口允许血肿排空而不会终止颅内记录。
