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立体脑电图期间的血管源性水肿:颅内模式和迟发性临床影响。

Vasogenic oedema during stereoelectroencephalography: intracranial pattern and late-onset clinical repercussion.

机构信息

Université Paris Saclay-APHP, Neurophysiologie et Epileptologie, Le Kremlin Bicêtre, France.

Université Paris Saclay-APHP, Neurochirurgie, Le Kremlin Bicêtre, France.

出版信息

J Neurol. 2024 Sep;271(9):6096-6101. doi: 10.1007/s00415-024-12577-w. Epub 2024 Jul 24.


DOI:10.1007/s00415-024-12577-w
PMID:39046522
Abstract

In patients suffering from focal drug-resistant epilepsy, intracranial explorations are the gold standard for identifying the epileptogenic zone and evaluating the possibility of a surgical resection. Amongst them, stereoelectroencephalography (SEEG), using depth electrodes, is a safe procedure. However, complications occur on average in 2% of cases, notably haemorrhages or infections. Vasogenic cerebral oedema constitutes a rarely reported complication. Amongst the 85 patients explored with SEEG between January 2017 and September 2023, three had a clinically and electrophysiologically relevant vasogenic cerebral oedema. In these three patients, the surgical procedure was uneventful. In all three as well, electrodes exploring areas away from the epileptogenic zone recorded some unexpected focal delta slowing with clinically asymptomatic superimposed discharges, a pattern so far only reported in cases of bleeding. Moreover, one patient experienced confusion 10 days after explantation. Post-explantation magnetic resonance imaging showed, in all three patients, a vasogenic oedema that fully resolved a few months later. We did not identify any contributing factors, and there were no particularities concerning the number of electrodes, their implantation site or the recording duration. Focal delta slowing and rhythmic discharges during SEEG can indicate a vasogenic oedema. Clinical consequences can occur after explantation. Evolution is favourable but this misleading pattern must be identified.

摘要

在患有局灶性耐药性癫痫的患者中,颅内探查是确定致痫区和评估手术切除可能性的金标准。其中,立体脑电图 (SEEG) 使用深部电极是一种安全的程序。然而,平均有 2%的病例会出现并发症,特别是出血或感染。血管源性脑水肿是一种罕见报道的并发症。在 2017 年 1 月至 2023 年 9 月期间接受 SEEG 探索的 85 名患者中,有 3 名患者出现临床和电生理相关的血管源性脑水肿。在这 3 名患者中,手术过程均顺利。在所有这 3 名患者中,远离致痫区的电极记录到一些意想不到的局灶性德尔塔减速伴临床无症状的叠加放电,这种模式迄今为止仅在出血病例中报道过。此外,一名患者在植入物取出后 10 天出现意识模糊。植入物取出后的磁共振成像显示,所有 3 名患者均存在血管源性脑水肿,几个月后完全消退。我们没有发现任何促成因素,电极数量、植入部位或记录时间没有特殊性。SEEG 期间的局灶性德尔塔减速和节律性放电可能表明存在血管源性脑水肿。在植入物取出后可能会出现临床后果。病情演变良好,但必须识别这种具有误导性的模式。

相似文献

[1]
Vasogenic oedema during stereoelectroencephalography: intracranial pattern and late-onset clinical repercussion.

J Neurol. 2024-9

[2]
Invasive EEG-electrodes in presurgical evaluation of epilepsies: Systematic analysis of implantation-, video-EEG-monitoring- and explantation-related complications, and review of literature.

Epilepsy Behav. 2018-6-13

[3]
Indications, technique, and safety profile of insular stereoelectroencephalography electrode implantation in medically intractable epilepsy.

J Neurosurg. 2017-6-16

[4]
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J Neurosurg. 2015-12

[5]
Individualized stereoelectroencephalography evaluation and navigated resection in medically refractory pediatric epilepsy.

Epilepsy Behav. 2020-11

[6]
Analysis of Morbidity and Outcomes Associated With Use of Subdural Grids vs Stereoelectroencephalography in Patients With Intractable Epilepsy.

JAMA Neurol. 2019-6-1

[7]
Safety and efficacy of stereoelectroencephalography in pediatric focal epilepsy: a single-center experience.

J Neurosurg Pediatr. 2018-10

[8]
Stereoelectroencephalography: Indication and Efficacy.

Neurol Med Chir (Tokyo). 2017-8-15

[9]
The stereotactic approach for mapping epileptic networks: a prospective study of 200 patients.

J Neurosurg. 2014-11

[10]
Methodology, outcome, safety and in vivo accuracy in traditional frame-based stereoelectroencephalography.

Acta Neurochir (Wien). 2017-9

本文引用的文献

[1]
Robotic-Assisted Stereoelectroencephalography: A Systematic Review and Meta-Analysis of Safety, Outcomes, and Precision in Refractory Epilepsy Patients.

Cureus. 2023-10-25

[2]
Implications of intracranial hemorrhage associated with stereo-EEG.

Clin Neurophysiol. 2023-11

[3]
The need to be alert to complications of peri-lead cerebral edema caused by deep brain stimulation implantation: A systematic literature review and meta-analysis study.

CNS Neurosci Ther. 2022-3

[4]
F-FDG-PET hypometabolic pattern reveals multifocal epileptic foci despite limited unique stereotyped seizures.

Epilepsy Res. 2021-5

[5]
Stereo-EEG ictal/interictal patterns and underlying pathologies.

Seizure. 2019-10-5

[6]
Stereoelectroencephalography: retrospective analysis of 742 procedures in a single centre.

Brain. 2019-9-1

[7]
Invasive EEG-electrodes in presurgical evaluation of epilepsies: Systematic analysis of implantation-, video-EEG-monitoring- and explantation-related complications, and review of literature.

Epilepsy Behav. 2018-6-13

[8]
Implantation of Stereoelectroencephalography Electrodes: A Systematic Review.

J Clin Neurophysiol. 2016-12

[9]
Seizure-onset patterns in focal cortical dysplasia and neurodevelopmental tumors: Relationship with surgical prognosis and neuropathologic subtypes.

Epilepsia. 2016-9

[10]
Is SEEG safe? A systematic review and meta-analysis of stereo-electroencephalography-related complications.

Epilepsia. 2016-3

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