Department of Neurosurgery, University of California, San Francisco, San Francisco, California.
Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina.
Oper Neurosurg (Hagerstown). 2021 Jan 13;20(2):E98-E109. doi: 10.1093/ons/opaa300.
The Responsive Neurostimulation (RNS)® System (NeuroPace, Inc) is an implantable device designed to improve seizure control in patients with medically refractory focal epilepsy. Because it is relatively new, surgical pearls and operative techniques optimized from experience beyond a small case series have yet to be described.
To provide a detailed description of our operative technique and surgical pearls learned from implantation of the RNS System in 57 patients at our institution. We describe our method for frame-based placement of amygdalo-hippocampal depth leads, open implantation of cortical strip leads, and open installation of the neurostimulator.
We outline considerations for patient selection, preoperative planning, surgical positioning, incision planning, stereotactic depth lead implantation, cortical strip lead implantation, craniotomy for neurostimulator implantation, device testing, closure, and intraoperative imaging.
The median reduction in clinical seizure frequency was 60% (standard deviation 63.1) with 27% of patients achieving seizure freedom at last follow up (median 23.1 mo). No infections, intracerebral hemorrhages, or lead migrations were encountered. Two patients experienced lead fractures, and four lead exchanges have been performed.
The techniques set forth here will help with the safe and efficient implantation of these new devices.
反应性神经刺激（RNS）®系统（NeuroPace，Inc.）是一种可植入装置，旨在改善药物难治性局灶性癫痫患者的癫痫控制。由于它相对较新，因此尚未描述从小型病例系列之外获得的手术要点和优化的操作技术。
提供我们在机构中对 57 名患者植入 RNS 系统的手术技术和手术要点的详细描述。我们描述了我们用于基于框架的杏仁核-海马深部导联放置、皮质条带导联开放式植入以及神经刺激器开放式安装的方法。
我们概述了患者选择、术前规划、手术定位、切口规划、立体定向深度导联植入、皮质条带导联植入、神经刺激器植入的开颅术、设备测试、关闭和术中成像的注意事项。
临床癫痫发作频率的中位数降低了 60%（标准差为 63.1），最后一次随访时 27%的患者无癫痫发作（中位数为 23.1 个月）。没有感染、颅内出血或导联移位。两名患者出现导联断裂，已进行了四次导联更换。
这里提出的技术将有助于这些新设备的安全和有效植入。
