Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
World Neurosurg. 2022 Nov;167:e196-e203. doi: 10.1016/j.wneu.2022.07.123. Epub 2022 Aug 6.
Stereoelectroencephalography (SEEG) has gained popularity as an invasive monitoring modality for epileptogenic zone (EZ) localization. The need and indications for SEEG in patients with evident brain lesions or associated abnormalities on imaging is debated. We report our experience with SEEG as a presurgical evaluation tool for patients with lesional epilepsy.
A retrospective cohort study was performed of 131 patients with lesional or magnetic resonance imaging abnormality-associated medically refractory focal epilepsy who underwent resections from 2010 to 2017. Seventy-one patients had SEEG followed by resection, and 60 had no invasive recordings. Volumetric analysis of resection cavities from 3T magnetic resonance imaging was performed.
Mean lesion and resection volumes for SEEG and non-SEEG were 16.2 (standard deviation [SD] = 29) versus 23.7 cm (SD = 38.4) and 28.1 (SD = 23.2) versus 43.6 cm (SD = 43.5), respectively (P = 0.009). Comparing patients with seizure recurrence and patients who remained seizure free, significantly associated variables with seizure recurrence included mean number of failed antiseizure medications (6.86 [SD = 0.32] vs. 5.75 [SD = 0.32]; P = 0.01) and in SEEG patients the mean number of electrodes implanted (8.1 [SD = 0.8] vs. 5.0 [SD = 0.8]; P = 0.005). After multivariate analysis, only failed numbers of medication remained significantly associated with seizure recurrence.
Seizure outcomes did not correlate with final resection volume after SEEG evaluation. SEEG evaluation presurgically can be used to maintain the efficacy of resection and decrease the volume and subsequent risk of extensive tissue removal. We believe that this technology allows resective surgery to proceed in a subpopulation of patients with lesional epilepsy who may otherwise not have been considered surgical candidates.
立体脑电图（SEEG）作为一种用于致痫区（EZ）定位的侵入性监测方式，已越来越受欢迎。对于存在明显脑部病变或影像学相关异常的患者，是否需要以及何种情况下需要进行 SEEG 存在争议。我们报告了我们使用 SEEG 作为有病变的癫痫患者术前评估工具的经验。
对 2010 年至 2017 年间接受手术切除的 131 例有病变或与磁共振成像异常相关的药物难治性局灶性癫痫患者进行了回顾性队列研究。71 例患者行 SEEG 检查后行切除术，60 例患者未行侵入性记录。对 3T 磁共振成像的切除腔进行容积分析。
SEEG 和非 SEEG 的平均病变和切除体积分别为 16.2cm（标准差[SD] 29）与 23.7cm（SD 38.4）和 28.1cm（SD 23.2）与 43.6cm（SD 43.5）（P=0.009）。比较术后癫痫复发患者和未复发患者，与癫痫复发显著相关的变量包括平均抗癫痫药物失败数（6.86 [SD 0.32] vs. 5.75 [SD 0.32]；P=0.01）和 SEEG 患者中植入的电极平均数（8.1 [SD 0.8] vs. 5.0 [SD 0.8]；P=0.005）。多变量分析后，只有药物失败数与癫痫复发显著相关。
SEEG 评估后的癫痫发作结果与最终切除体积无关。术前 SEEG 评估可用于维持切除的疗效，并减少切除体积和随后的广泛组织切除风险。我们认为，这项技术可以使有病变的癫痫患者的手术切除手术得以进行，否则这些患者可能不被认为是手术候选者。
