Nakae Shunsuke, Kumon Masanobu, Teranishi Takao, Ohba Shigeo, Hirose Yuichi
Department of Neurosurgery, Fujita Health University, Toyoake 470-1192, Japan.
Brain Sci. 2023 Mar 13;13(3):482. doi: 10.3390/brainsci13030482.
Fence-post catheter techniques are used to use tumor margins when resecting gliomas. In the present study, deep electrodes instead of catheters were used as fence-posts. The case of a 25-year-old female patient whose magnetic resonance images (MRI) revealed a tumor in the left cingulate gyrus is presented in this study. She underwent daily seizures without loss of consciousness under the administration of anti-seizure medications. Despite video electroencephalography (EEG) monitoring, the scalp inter-ictal EEG did not show obvious epileptiform discharges. We were consequently uncertain whether such frequent seizures were epileptic seizures or not. As a result, deep electrodes were used as fence-posts: three deep electrodes were inserted into the tumor's anterior, lateral, and posterior margins using a navigation-guided method. The highest epileptic discharge was detected from the anterior deep electrode. As a result, ahead of the tumor was extendedly resected, and epileptic discharges were eliminated using EEG. The postoperative MRI revealed that the tumor was resected. The patient has never experienced seizures after the surgery. In conclusion, when supratentorial gliomas complicated by frequent seizures are resected, intraoperative EEG monitoring using deep electrodes as fence-posts is useful for estimating epileptogenic areas.
在切除胶质瘤时，采用栅栏式导管技术来确定肿瘤边界。在本研究中，使用深部电极而非导管作为栅栏。本文介绍了一名25岁女性患者的病例，其磁共振成像（MRI）显示左侧扣带回有肿瘤。在服用抗癫痫药物的情况下，她每天都会发作癫痫，但意识未丧失。尽管进行了视频脑电图（EEG）监测，但头皮发作间期脑电图并未显示明显的癫痫样放电。因此，我们不确定如此频繁的发作是否为癫痫发作。结果，使用深部电极作为栅栏：采用导航引导方法将三根深部电极插入肿瘤的前缘、侧缘和后缘。从前深部电极检测到最高的癫痫放电。结果，在肿瘤前方进行了扩大切除，并通过脑电图消除了癫痫放电。术后MRI显示肿瘤已被切除。患者术后从未再经历过癫痫发作。总之，在切除伴有频繁发作的幕上胶质瘤时，使用深部电极作为栅栏进行术中脑电图监测有助于评估致痫区域。
