De Barros Amaury, Zaldivar-Jolissaint Julien Francisco, Hoffmann Dominique, Job-Chapron Anne-Sophie, Minotti Lorella, Kahane Philippe, De Schlichting Emmanuel, Chabardès Stephan
Department of Neurosurgery, Toulouse University Hospital, Toulouse, France.
CHU Grenoble Alpes, Clinical University of Neurosurgery, Grenoble, France.
Front Neurol. 2020 Sep 17;11:1033. doi: 10.3389/fneur.2020.01033. eCollection 2020.
Stereo-electro-encephalography (SEEG) is an invasive, surgical, and electrophysiological method for three-dimensional registration and mapping of seizure activity in drug-resistant epilepsy. It allows the accurate analysis of spatio-temporal seizure activity by multiple intraparenchymal depth electrodes. The technique requires rigorous non-invasive pre-SEEG evaluation (clinical, video-EEG, and neuroimaging investigations) in order to plan the insertion of the SEEG electrodes with minimal risk and maximal recording accuracy. The resulting recordings are used to precisely define the surgical limits of resection of the epileptogenic zone in relation to adjacent eloquent structures. Since the initial description of the technique by Talairach and Bancaud in the 1950's, several techniques of electrode insertion have been used with accuracy and relatively few complications. In the last decade, robot-assisted surgery has emerged as a safe, accurate, and time-saving electrode insertion technique due to its unparalleled potential for orthogonal and oblique insertion trajectories, guided by rigorous computer-assisted planning. SEEG exploration of the insular cortex remains difficult due to its anatomical location, hidden by the temporal and frontoparietal opercula. Furthermore, the close vicinity of Sylvian vessels makes surgical electrode insertion challenging. Some epilepsy surgery teams remain cautious about insular exploration due to the potential of neurovascular injury. However, several authors have published encouraging results regarding the technique's accuracy and safety in both children and adults. We will review the indications, techniques, and outcomes of insular SEEG exploration with emphasis on robot-assisted implantation.
立体定向脑电图（SEEG）是一种侵入性的手术电生理方法，用于对药物难治性癫痫的癫痫发作活动进行三维定位和映射。它通过多个脑实质内深度电极对癫痫发作的时空活动进行精确分析。该技术需要进行严格的SEEG前无创评估（临床、视频脑电图和神经影像学检查），以便以最小风险和最大记录准确性来规划SEEG电极的插入。所得记录用于精确界定癫痫发作起源区相对于相邻功能区结构的手术切除范围。自20世纪50年代Talairach和Bancaud首次描述该技术以来，已使用了多种电极插入技术，这些技术准确性高且并发症相对较少。在过去十年中，机器人辅助手术已成为一种安全、准确且节省时间的电极插入技术，因为在严格的计算机辅助规划引导下，它在正交和斜向插入轨迹方面具有无与伦比的潜力。由于岛叶皮质的解剖位置被颞叶和额顶叶脑盖覆盖，对其进行SEEG探索仍然困难。此外，大脑外侧裂血管紧邻，使得手术电极插入具有挑战性。由于存在神经血管损伤的可能性，一些癫痫手术团队对岛叶探索仍持谨慎态度。然而，几位作者已发表有关该技术在儿童和成人中的准确性和安全性的令人鼓舞的结果。我们将重点回顾机器人辅助植入的岛叶SEEG探索的适应症、技术和结果。
