Department of Neurosurgery, Nagoya University School of Medicine.
Brain and Mind Research Center, Nagoya University.
Neurol Med Chir (Tokyo). 2023 May 15;63(5):179-190. doi: 10.2176/jns-nmc.2022-0271. Epub 2023 Mar 31.
Stereotactic electroencephalography (SEEG) is receiving increasing attention as a safe and effective technique in the invasive evaluation for epileptogenic zone (EZ) detection. The main clinical question is whether the use of SEEG truly improves outcomes. Herein, we compared outcomes in our patients after three types of intracranial EEG (iEEG): SEEG, the subdural electrode (SDE), and a combined method using depth and strip electrodes. We present here our preliminary results from two demonstrative cases. Several international reports from large epilepsy centers found the following clinical advantages of SEEG: 1) three-dimensional analysis of structures, including bilateral and multilobar structures; 2) low rate of complications; 3) less pneumoencephalopathy and less patient burden during postoperative course, which allows the initiation of video-EEG monitoring immediately after implantation and does not require resection to be performed in the same hospitalization; and 4) a higher rate of good seizure control after resection. In other words, SEEG more accurately identified the EZ than the SDE method. We obtained similar results in our preliminary experiences under limited conditions. In Japan, as of August 2022, dedicated electrodes and SEEG accessories have not been approved and the use of the robot arm is not widespread. The Japanese medical community is hopeful that these issues will soon be resolved and that the experience with SEEG in Japan will align with that of large epilepsy centers internationally.
立体定向脑电图(SEEG)作为一种安全有效的癫痫灶(EZ)检测侵袭性评估技术,越来越受到关注。主要的临床问题是 SEEG 的使用是否确实能改善结果。在此,我们比较了三种颅内脑电图(iEEG):SEEG、硬膜下电极(SDE)和使用深部和条状电极的联合方法在我们的患者中的结果。我们在此展示两个示范病例的初步结果。几个国际大型癫痫中心的报告发现了 SEEG 的以下临床优势:1)对结构的三维分析,包括双侧和多脑叶结构;2)并发症发生率低;3)术后气脑发生率低,患者负担小,这允许在植入后立即开始视频脑电图监测,并且不需要在同一住院期间进行切除;4)切除后癫痫控制率更高。换句话说,SEEG 比 SDE 方法更准确地确定了 EZ。在我们有限条件下的初步经验中,我们获得了类似的结果。在日本,截至 2022 年 8 月,专用电极和 SEEG 附件尚未获得批准,并且机器人臂的使用并不广泛。日本医学界希望这些问题将很快得到解决,日本的 SEEG 经验将与国际上的大型癫痫中心一致。
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