Gadot Ron, Korst Genevieve, Shofty Ben, Gavvala Jay R, Sheth Sameer A
Departments of1Neurosurgery and.
2Neurology, Baylor College of Medicine, Houston, Texas.
J Neurosurg. 2022 Mar 11;137(5):1210-1225. doi: 10.3171/2022.1.JNS212613. Print 2022 Nov 1.
Stereoelectroencephalography (sEEG) is a well-established surgical method for defining the epileptogenic network. Traditionally reserved for identifying discrete cortical regions for resection or ablation, sEEG in current practice is also used for identifying more broadly involved subcortical epileptic network components, driven by the availability of brain-based neuromodulation strategies. In particular, sEEG investigations including thalamic nuclei are becoming more frequent in parallel with the increase in therapeutic strategies involving thalamic targets such as deep brain stimulation (DBS) and responsive neurostimulation (RNS). The objective to this study was to evaluate existing evidence and trends regarding the purpose, techniques, and relevant electrographic findings of thalamic sEEG.
MEDLINE and Embase databases were systematically queried for eligible peer-reviewed studies involving sEEG electrode implantation into thalamic nuclei of patients with epilepsy. Available data were abstracted concerning preoperative workup and purpose for implanting the thalamus, thalamic targets and trajectories, and electrophysiological methodology and findings.
sEEG investigations have included thalamic targets for both basic and clinical research purposes. Medial pulvinar, dorsomedial, anterior, and centromedian nuclei have been the most frequently studied. Few studies have reported any complications with thalamic sEEG implantation, and no studies have reported long-term complications. Various methods have been utilized to characterize thalamic activity in epileptic disorders including evoked potentials, power spectrograms, synchronization indices, and the epileptogenicity index. Thalamic intracranial recordings are beginning to be used to guide neuromodulation strategies including RNS and DBS, as well as to understand complex, network-dependent seizure disorders.
Inclusion of thalamic coverage during sEEG evaluation in drug-resistant epilepsy is a growing practice and is amenable to various methods of electrographic data analysis. Further study is required to establish well-defined criteria for thalamic implantation during invasive investigations as well as safety and ethical considerations.
立体定向脑电图（sEEG）是一种成熟的用于确定致痫网络的手术方法。传统上sEEG用于确定离散的皮质区域以进行切除或消融，而在当前实践中，由于基于脑的神经调节策略的可用性，sEEG也用于识别更广泛涉及的皮质下癫痫网络成分。特别是，随着涉及丘脑靶点（如深部脑刺激（DBS）和反应性神经刺激（RNS））的治疗策略的增加，包括丘脑核的sEEG研究越来越频繁。本研究的目的是评估有关丘脑sEEG的目的、技术和相关脑电图结果的现有证据和趋势。
系统检索MEDLINE和Embase数据库，以查找涉及将sEEG电极植入癫痫患者丘脑核的符合条件的同行评审研究。提取有关术前检查和丘脑植入目的、丘脑靶点和轨迹以及电生理方法和结果的可用数据。
sEEG研究包括用于基础研究和临床研究目的的丘脑靶点。内侧枕核、背内侧核、前核和中央中核是研究最频繁的。很少有研究报告丘脑sEEG植入有任何并发症，也没有研究报告长期并发症。已经采用了各种方法来表征癫痫疾病中的丘脑活动，包括诱发电位、功率谱图、同步指数和致痫性指数。丘脑颅内记录开始用于指导包括RNS和DBS在内的神经调节策略，以及理解复杂的、依赖网络的癫痫发作障碍。
在耐药性癫痫的sEEG评估中纳入丘脑覆盖是一种越来越普遍的做法，并且适用于各种脑电图数据分析方法。需要进一步研究以建立侵入性检查期间丘脑植入的明确标准以及安全性和伦理考量。
