难治性癫痫侵袭性评估中颅内皮层电极的应用与并发症分析

Application and complications of subdural electrodes implantation in preoperative assessment of intractable epilepsy surgery

目的探讨在难治性癫痫术前评估中颅内皮层电极埋藏的方法与安全性。方法回顾性分析湘雅医院功能神经外科2014年4月～2017年6月开展的65例颅内皮层电极埋置患者的临床资料,总结颅内皮层电极埋置在癫痫术前评估中的经验。结果 65例患者均采用开颅埋置皮层片状电极,其中38例辅助埋置深部电极。患者术后平均监测时间为10. 8天(2～28天)。术后颅内血肿8例,其中硬膜外血肿4例,硬膜下血肿4例,有3例患者因硬膜外血肿行手术清除血肿,术后伤口脑脊液漏12例,术后颅内感染3例,均为并发脑脊液漏患者,脑水肿1例,电极脱出1例。无因并发症放弃监测病例,无埋置手术长期并发症及神经功能受损病例。结论颅内皮层电极埋置在癫痫外科中是一项重要的安全有效的侵袭性术前评估方法,术后出血及感染是主要的并发症,适当的术中、术后处理将有助于避免相关并发症。

Objective To investigate the methods and safety of subdural electrodes implantation in intractable epilepsy patients for pre-surgical assessment. Methods The clinical data of 65 patients who underwent implantation surgery of subdural electrodes with or without depth electrodes at functional neurosurgery in Xiangya Hospital from April 2014 to June 2017 were retrospectively analyzed. We summarized the experience of implantation and analyzed complications. Results All 65 patients underwent craniotomy to implant subdural electrodes, of which 26 implanted additional depth electrodes. The mean duration of implantation was 10.8 days（2~28days）. Postoperative intracranial hematoma occurred in 8 cases, including 4 cases of epidural hematoma, 4 of subdural hematoma. 3 patients suffered of epidural hematoma needed additional surgery to removal of hematoma. Cerebrospinal fluid leakage occurred in 8 cases, and postoperative intracranial infection in 3 cases, cerebral edema in 1 cases, electrode prolapse in 1 case. No patient failed monitoring due to the complications and no patient suffered long-term neurological deficit due to the implantation. Conclusions Intracranial subdural electrodes with or without depths electrodes implantation and long-term monitoring is a relatively safe and useful invasive preoperative assessment method. Postoperative intracranial hematoma and infection are the main complications and appropriate placement method and postoperative management will help to avoid the complications.