Alotaibi Faisal, Mir Ali, Al-Faraidy Mona, Jallul Tareq, Al-Baradie Raidah
College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
Neuroscience Centre, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
Epilepsy Behav Rep. 2021 Dec 25;17:100521. doi: 10.1016/j.ebr.2021.100521. eCollection 2022.
Intraoperative functional language mapping is vital to minimize the risks associated with surgical removal of the seizure onset zone in selected patients with epilepsy. In children, this method has been reported extraoperatively by the placement of invasive electrodes to map the language area and monitor epileptic activity. It is difficult from a technical standpoint to perform an awake craniotomy and language mapping in young children under 10 years of age. Here we report a 9-year-old boy suffering from drug-resistant non-lesional epilepsy who underwent extraoperative and intraoperative electrical stimulation with successful identification of Broca's language area. Electrocorticography (ECOG) was applied intraoperatively in a continuous manner utilizing grid electrodes before the skin opening. We found that the use of visual digital video games facilitated extraoperative and intraoperative cortical mapping. Cortical language inhibition by electrical stimulation was elicited at an amplitude of 7 mA (100 μs single-phase duration and 50 Hz pulse width). Resection of the seizure onset zone was completed safely. The post-resection ECOG revealed the disappearance of epileptogenic electrographic discharges at the seizure onset contacts and at other involved contacts in the epileptogenic zone. After surgery, the child recovered well with no language deficits and remained seizure-free. The child remembered only the video game test that was performed intraoperatively. This report highlights safety strategies for awake language mapping in pediatrics and the importance of the perioperative use of a visual digital video game and continuous ECOG, in addition to the use of targeted language cortex stimulation to facilitate faster and safer intraoperative language mapping under awake conditions in this age group.
术中功能语言映射对于将选定癫痫患者手术切除癫痫发作起始区相关风险降至最低至关重要。在儿童中，已通过放置侵入性电极在术外进行这种方法来绘制语言区域并监测癫痫活动。从技术角度来看，对10岁以下幼儿进行清醒开颅手术和语言映射很困难。在此，我们报告一名9岁患有耐药性非病变性癫痫的男孩，他接受了术外和术中电刺激，成功识别出了布罗卡语言区。在切开皮肤前，术中使用栅格电极以连续方式应用皮质脑电图（ECOG）。我们发现使用视觉数字视频游戏有助于术外和术中皮质映射。在7 mA（单相持续时间100 μs和脉冲宽度50 Hz）的幅度下可引发电刺激引起的皮质语言抑制。癫痫发作起始区的切除安全完成。切除术后的ECOG显示癫痫发作起始触点和癫痫源区其他受累触点处的致痫性电图放电消失。手术后，该儿童恢复良好，无语言缺陷，且保持无癫痫发作。该儿童只记得术中进行的视频游戏测试。本报告强调了儿科清醒语言映射的安全策略，以及围手术期使用视觉数字视频游戏和连续ECOG的重要性，此外还强调了使用靶向语言皮质刺激以在该年龄组清醒条件下促进更快、更安全的术中语言映射。
