Sato Yosuke, Tsuji Yoshihito, Kawauchi Yuta, Iizuka Kazuki, Kobayashi Yusuke, Irie Ryo, Sugiyama Tatsuya, Mizutani Tohru
Department of Neurosurgery, Showa University School of Medicine, Tokyo, Japan; and.
Department of Neurosurgery, Matsubara Tokushukai Hospital, Osaka, Japan.
J Neurosurg Case Lessons. 2021 Jan 25;1(4):CASE20121. doi: 10.3171/CASE20121.
In epilepsy surgery for cavernoma with intractable focal epilepsy, removal of the cavernoma with its surrounding hemosiderin deposition and other extended epileptogenic zone has been shown to improve postsurgical seizures. However, there has been no significant association between such an epileptogenic zone and intraoperative electrocorticography (ECoG) findings. The authors recently demonstrated that high regular gamma oscillation (30-70 Hz) regularity (GOR) significantly correlates with epileptogenicity.
The authors evaluated the utility of intraoperative GOR analysis in epilepsy surgery for cavernomas. The authors also analyzed intraoperative ECoG data from 6 patients with cavernomas. The GOR was calculated using a sample entropy algorithm. In 4 patients, the GOR was significantly high in the area with the pathological hemosiderin deposition. In 2 patients with temporal cavernoma, the GOR was significantly high in both the hippocampus and the area with the pathological hemosiderin deposition. ECoG showed no obvious epileptic waveforms in 3 patients, whereas extensive spikes were observed in 3 patients. All patients underwent cavernoma removal plus resection of the area with significantly high GOR. The 2 patients with temporal cavernomas underwent additional hippocampal transection. All patients were seizure free after surgery.
The high GOR may be a novel intraoperative marker of the epileptogenic zone in epilepsy surgery for cavernomas.
在针对伴有难治性局灶性癫痫的海绵状血管瘤进行癫痫手术时，切除海绵状血管瘤及其周围的含铁血黄素沉积和其他扩展的致痫区域已被证明可改善术后癫痫发作。然而，这样的致痫区域与术中皮质脑电图（ECoG）结果之间并无显著关联。作者最近证明，高规则伽马振荡（30 - 70赫兹）规律性（GOR）与致痫性显著相关。
作者评估了术中GOR分析在海绵状血管瘤癫痫手术中的效用。作者还分析了6例海绵状血管瘤患者的术中ECoG数据。使用样本熵算法计算GOR。在4例患者中，病理性含铁血黄素沉积区域的GOR显著升高。在2例颞叶海绵状血管瘤患者中，海马体和病理性含铁血黄素沉积区域的GOR均显著升高。3例患者的ECoG未显示明显的癫痫波形，而3例患者观察到广泛的棘波。所有患者均接受了海绵状血管瘤切除及GOR显著升高区域的切除。2例颞叶海绵状血管瘤患者还接受了额外的海马横切术。所有患者术后均无癫痫发作。
高GOR可能是海绵状血管瘤癫痫手术中致痫区域的一种新型术中标志物。
