Department of Neurosurgery, Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital.
Neurol Med Chir (Tokyo). 2020 Dec 15;60(12):581-593. doi: 10.2176/nmc.ra.2020-0197. Epub 2020 Nov 18.
Fruitful progress and change have been accomplished in epilepsy surgery as science and technology advance. Stereotactic electroencephalography (SEEG) was originally developed by Talairach and Bancaud at Hôspital Sainte-Anne in the middle of the 20th century. SEEG has survived, and is now being recognized once again, especially with the development of neurosurgical robots. Many epilepsy centers have already replaced invasive monitoring with subdural electrodes (SDEs) by SEEG with depth electrodes worldwide. SEEG has advantages in terms of complication rates as shown in the previous reports. However, it would be more indispensable to demonstrate how much SEEG has contributed to improving seizure outcomes in epilepsy surgery. Vagus nerve stimulation (VNS) has been an only implantable device since 1990s, and has obtained the autostimulation mode which responds to ictal tachycardia. In addition to VNS, responsive neurostimulator (RNS) joined in the options of palliative treatment for medically refractory epilepsy. RNS is winning popularity in the United States because the device has abilities of both neurostimulation and recording of ambulatory electrocorticography (ECoG). Deep brain stimulation (DBS) has also attained approval as an adjunctive therapy in Europe and the United States. Ablative procedures such as SEEG-guided radiofrequency thermocoagulation (RF-TC) and laser interstitial thermal therapy (LITT) have been developed as less invasive options in epilepsy surgery. There will be more alternatives and tools in this field than ever before. Consequently, we will need to define benefits, indications, and limitations of these new technologies and concepts while adjusting ourselves to a period of fundamental transition in our foreseeable future.
随着科学技术的进步，癫痫手术取得了丰硕的进展和变革。立体定向脑电图（SEEG）最初由 Talairach 和 Bancaud 于 20 世纪中叶在 Sainte-Anne 医院开发。SEEG 得以幸存，现在又重新得到认可，尤其是随着神经外科机器人的发展。许多癫痫中心已经在全球范围内用深部电极取代了有创监测的皮下电极（SDE）。SEEG 在并发症发生率方面具有优势，这在前瞻性报告中已有体现。然而，更重要的是要证明 SEEG 在改善癫痫手术中的癫痫发作结局方面做出了多大的贡献。迷走神经刺激（VNS）自 20 世纪 90 年代以来一直是一种可植入设备，并且已经获得了对发作性心动过速有反应的自动刺激模式。除了 VNS，反应性神经刺激器（RNS）也加入了对药物难治性癫痫的姑息治疗选择。由于该设备具有神经刺激和动态皮质电图（ECoG）记录的能力，RNS 在美国越来越受欢迎。深部脑刺激（DBS）也已在欧洲和美国获得辅助治疗的批准。SEEG 引导下的射频热凝（RF-TC）和激光间质热疗（LITT）等消融性手术已成为癫痫手术中微创的选择。在这个领域，将有比以往更多的选择和工具。因此，我们需要在调整自己以适应未来可预见的基础转型期的同时，确定这些新技术和概念的优势、适应证和局限性。
