Université Paris Saclay-APHP, Neurophysiologie et Epileptologie, Le Kremlin Bicêtre, France.
Université Paris Saclay-APHP, Neurochirurgie, Le Kremlin Bicêtre, France.
J Neurol. 2024 Sep;271(9):6096-6101. doi: 10.1007/s00415-024-12577-w. Epub 2024 Jul 24.
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.
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。
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