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美国儿科神经外科医生在小儿立体脑电图实践中的差异:调查结果。

Variation in pediatric stereoelectroencephalography practice among pediatric neurosurgeons in the United States: survey results.

作者信息

Kennedy Benjamin C, Katz Joshua, Lepard Jacob, Blount Jeffrey P

机构信息

1Division of Pediatric Neurosurgery, Department of Neurosurgery, Children's Hospital of Philadelphia.

2Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania.

出版信息

J Neurosurg Pediatr. 2021 Jun 18;28(2):212-220. doi: 10.3171/2021.1.PEDS20799. Print 2021 Aug 1.


DOI:10.3171/2021.1.PEDS20799
PMID:34144513
Abstract

OBJECTIVE: Stereoelectroencephalography (SEEG) has become widespread in the United States during the past decade. Many pediatric neurosurgeons practicing SEEG may not have had experience with this technique during their formal training, and the literature is mostly limited to single-center series. As a result, implementation of this relatively new technique may vary at different institutions. The authors hypothesized that aspects of SEEG experience, techniques, and outcomes would vary widely among programs across the country. METHODS: An electronic survey with 35 questions addressing the categories of training and experience, technique, electrode locations, and outcomes was sent to 128 pediatric epilepsy surgeons who were potential SEEG users. RESULTS: Sixty-one pediatric fellowship-trained epilepsy surgeons in the United States responded to the survey. Eighty-nine percent were actively using SEEG in their practice. Seventy-two percent of SEEG programs were in existence for less than 5 years, and 68% were using SEEG for > 70% of their invasive monitoring. Surgeons at higher-volume centers operated on younger patients (p < 0.001). Most surgeons (70%) spent 1-3 hours per case planning electrode trajectories. Two-thirds of respondents reported a median implant duration of 5-7 days, but 16% reported never having an implant duration > 5 days, and 16% reported having had implants stay in place for > 4 weeks. The median response for the median number of electrodes initially implanted was 12 electrodes, although 19% of respondents reported median implants of 5-8 electrodes and 17% reported median implants of 15-18 electrodes. Having a higher volume of SEEG cases per year was associated with a higher median number of electrodes implanted (p < 0.001). Most surgeons found SEEG helpful in defining an epileptic network and reported that most of their SEEG patients undergo focal surgical treatment. CONCLUSIONS: SEEG has been embraced by the pediatric epilepsy surgery community. Higher case volume is correlated with a tendency to place more electrodes and operate on younger patients. For most parameters addressed in the survey, responses from surgeons clustered around a norm, though additional findings of substantial variations highlight differences in implementation and philosophy among pediatric epilepsy programs.

摘要

目的:在过去十年中,立体定向脑电图(SEEG)在美国已广泛应用。许多实施SEEG的儿科神经外科医生在其正规培训期间可能没有接触过这项技术,并且相关文献大多局限于单中心研究。因此,这项相对较新的技术在不同机构的应用可能存在差异。作者推测,SEEG的经验、技术和结果在全国不同项目之间会有很大差异。 方法:向128名可能使用SEEG的儿科癫痫外科医生发送了一份包含35个问题的电子调查问卷,问题涉及培训与经验、技术、电极位置和结果等类别。 结果:美国61名接受过儿科专科培训的癫痫外科医生回复了该调查问卷。89%的医生在实际工作中积极使用SEEG。72%的SEEG项目开展时间不到5年,68%的项目将SEEG用于超过70%的侵入性监测。手术量较大中心的外科医生为年龄较小的患者实施手术(p<0.001)。大多数外科医生(70%)每例手术花费1 - 3小时规划电极轨迹。三分之二的受访者报告植入电极的中位持续时间为5 - 7天,但16%的受访者报告植入电极的持续时间从未超过5天,16%的受访者报告植入电极的时间超过4周。最初植入电极的中位数的中位回复是12根电极,不过19%的受访者报告植入电极的中位数为5 - 8根,17%的受访者报告植入电极的中位数为15 - 18根。每年进行SEEG手术的病例数较多与植入电极的中位数较高相关(p<0.001)。大多数外科医生发现SEEG有助于明确癫痫网络,并报告他们的大多数SEEG患者接受了局灶性手术治疗。 结论:SEEG已被儿科癫痫外科领域所接受。较高的病例数与植入更多电极以及为年龄较小的患者实施手术的倾向相关。对于调查问卷中涉及的大多数参数,外科医生的回答集中在一个标准周围,不过其他显著差异的结果凸显了儿科癫痫项目在实施和理念上的差异。

相似文献

[1]
Variation in pediatric stereoelectroencephalography practice among pediatric neurosurgeons in the United States: survey results.

J Neurosurg Pediatr. 2021-6-18

[2]
Stereoelectroencephalography followed by combined electrode removal and MRI-guided laser interstitial thermal therapy or open resection: a single-center series in pediatric patients with medically refractory epilepsy.

J Neurosurg Pediatr. 2023-3-1

[3]
Safety and efficacy of stereoelectroencephalography in pediatric focal epilepsy: a single-center experience.

J Neurosurg Pediatr. 2018-10

[4]
Postoperative outcomes following pediatric intracranial electrode monitoring: A case for stereoelectroencephalography (SEEG).

Epilepsy Behav. 2020-2-3

[5]
Stereotactic EEG Practices: A Survey of United States Tertiary Referral Epilepsy Centers.

J Clin Neurophysiol. 2022-9-1

[6]
Robot-assisted insular stereoelectroencephalography in pediatric drug-resistant epilepsy: accuracy and diagnostic value.

Childs Nerv Syst. 2024-11

[7]
Early outcomes of stereoelectroencephalography followed by MR-guided laser interstitial thermal therapy: a paradigm for minimally invasive epilepsy surgery.

Neurosurg Focus. 2018-9

[8]
Frameless robot-assisted stereoelectroencephalography in children: technical aspects and comparison with Talairach frame technique.

J Neurosurg Pediatr. 2018-7

[9]
Contemporaneous evaluation of patient experience, surgical strategy, and seizure outcomes in patients undergoing stereoelectroencephalography or subdural electrode monitoring.

Epilepsia. 2021-1

[10]
Stereoelectroencephalography before 2 years of age.

Neurosurg Focus. 2022-10

引用本文的文献

[1]
A pediatrician's guide to epilepsy surgery.

Curr Probl Pediatr Adolesc Health Care. 2024-7

[2]
Safety, Accuracy, and Efficacy of Robot-Assisted Stereo Electroencephalography in Children of Different Ages.

Neurosurgery. 2024-2-1

[3]
Intraparenchymal and Subarachnoid Hemorrhage in Stereotactic Electroencephalography Caused by Indirect Adjacent Arterial Injury: Illustrative Case.

Brain Sci. 2023-3-4

[4]
Reliability of visual review of intracranial electroencephalogram in identifying the seizure onset zone: A systematic review and implications for the accuracy of automated methods.

Epilepsia. 2023-1

[5]
Stereoelectroencephalography in the very young: Case report.

Epilepsy Behav Rep. 2022-5-18

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