Department of Neurosurgery, Alfred Hospital, Melbourne, VIC, Australia; Department of Neuroscience, Alfred Hospital, Melbourne, VIC, Australia; Monash University, VIC, Australia.
Department of Neurosurgery, Alfred Hospital, Melbourne, VIC, Australia.
J Clin Neurosci. 2024 Sep;127:110762. doi: 10.1016/j.jocn.2024.110762. Epub 2024 Jul 29.
BACKGROUND: Stereoelectroencephalography (SEEG) is a procedure used to localize the epileptogenic zone in patients with medically refractory epilepsy, involving the stereotactic implantation of electrodes into brain parenchyma. Magnetic Resonance Imaging (MRI), Digital Subtraction Angiography, and Computed Tomography have been used preoperatively to prevent Intracranial Hemorrhage (ICH) by identifying electrode-vessel conflicts (EVC's) on planned electrode trajectories. There is variation in the use of Digital Subtraction Angiography and non-invasive sequences for vascular planning. Digital Subtraction Angiography provides high spatial resolution, but carries risks of arterial dissection, groin and retroperitoneal hematoma, and a 0.5-1.9% risk of stroke. Our group has incorporated Intravenous Cone Beam Computed Tomography (CBCT A/V) Brain into our SEEG workflow, given its effective implementation in other neurosurgical domains. Primary aims include validating the safety of our CBCT A/V sequence for SEEG planning and determining if CBCT A/V is comparable to other modalities in detecting EVC's. Secondary aims include elucidating the relationship of conflicting vessel calibre with ICH incidence in SEEG using CBCT A/V imaging. METHODS: A single-center retrospective study was conducted of 20 patients who underwent preoperative CBCT A/V Brain and MRI Brain with gadolinium enhancement, encompassing 273 electrode implantations from August 2020 - July 2023. The incidence and grade of post-implant, post-explant symptomatic ICH and asymptomatic ICH was noted. The total number of EVC's identifiable on MRI and CBCT A/V was recorded, along with average diameter of conflicting vessels. RESULTS: Across 20 patients and 273 implanted electrodes, there were four ICH events, where two were symptomatic and two were asymptomatic. The mean diameter of EVC's across all patients was 1.4 mm (±0.5). A significant difference (P < 0.0001) was observed between the number of EVC's that CBCT A/V could identify (20) compared to MRI (6). Two EVC's were identified in the region of two symptomatic ICH's, with the mean diameter of these conflicted vessels being 1.5 mm (±0.4). The two symptomatic ICH-associated EVC's were observed on CBCT A/V but not MRI. CONCLUSIONS: In our series, CBCT A/V demonstrates an acceptable safety profile for SEEG planning compared to other imaging modalities. CBCT A/V identified significantly more EVC's compared to MRI, including those contributing to transient symptomatic intracranial hemorrhage. A conflicting vessel calibre of less than 1.2 mm on CBCT A/V did not contribute to ICH in our SEEG series.
背景：立体脑电图（SEEG）是一种用于定位药物难治性癫痫患者致痫区的方法，涉及将电极立体定向植入脑实质。磁共振成像（MRI）、数字减影血管造影和计算机断层扫描已用于术前通过识别计划电极轨迹上的电极-血管冲突（EVC）来预防颅内出血（ICH）。数字减影血管造影和血管规划的非侵入性序列的使用存在差异。数字减影血管造影提供高空间分辨率，但存在动脉夹层、腹股沟和腹膜后血肿以及 0.5-1.9%中风风险。我们的团队已经将静脉锥形束计算机断层扫描（CBCT A/V）脑纳入我们的 SEEG 工作流程，因为它在其他神经外科领域的有效实施。主要目的包括验证我们的 CBCT A/V 序列用于 SEEG 规划的安全性，并确定 CBCT A/V 在检测 EVC 方面是否与其他方式相当。次要目的包括阐明使用 CBCT A/V 成像在 SEEG 中冲突血管口径与 ICH 发生率的关系。 方法：对 2020 年 8 月至 2023 年 7 月期间接受术前 CBCT A/V 脑和 MRI 脑增强扫描的 20 例患者进行了单中心回顾性研究，共进行了 273 次电极植入。记录了术后、术后症状性 ICH 和无症状性 ICH 的发生率和等级。记录了 MRI 和 CBCT A/V 可识别的 EVC 总数，以及冲突血管的平均直径。 结果：在 20 名患者和 273 个植入电极中，有 4 例 ICH 事件，其中 2 例为症状性，2 例为无症状性。所有患者的 EVC 平均直径为 1.4 ±0.5mm。CBCT A/V 可识别的 EVC 数量（20）与 MRI（6）相比，差异有统计学意义（P<0.0001）。在 2 例症状性 ICH 中发现了 2 个 EVC，这些冲突血管的平均直径为 1.5 ±0.4mm。这两个与症状性 ICH 相关的 EVC 在 CBCT A/V 上可见，但在 MRI 上不可见。 结论：在我们的系列中，与其他成像方式相比，CBCT A/V 为 SEEG 规划提供了可接受的安全性。与 MRI 相比，CBCT A/V 可识别出更多的 EVC，包括导致短暂症状性颅内出血的 EVC。在我们的 SEEG 系列中，直径小于 1.2mm 的冲突血管口径不会导致 ICH。
J Clin Neurosci. 2024-9
Neurol Med Chir (Tokyo). 2017-8-15
Medicine (Baltimore). 2017-6
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