立体脑电图在198例颞岛叶癫痫术前评估中的应用

Application of stereoelectroencephalography in preoperative evaluation of 198 temporal insula epilepsy:single center experience

目的探讨立体脑电图(SEEG)在颞岛叶药物难治性癫痫患者诊疗过程中的安全性和有效性。方法回顾性分析2014年9月—2020年12月在广东三九脑科医院癫痫中心进行SEEG置入电极患者的临床资料。所有患者均经过术前详细无创评估(包括记录发作期头皮脑电图、颅脑核磁共振成像、发作间歇期PET-CT、神经心理评估等),使用ROSA机器人置入颅内电极,监测发作间期及发作期脑电图,记录惯常发作,根据发作期颅内电极脑电图结果明确癫痫灶起始及确定功能区位置后进行手术切除。结果共564例患者接受SEEG电极置入术,其中成人414例,儿童150例。置入电极总数为6190根,其中颞、岛叶SEEG置入患者198例,共置入电极2147根。颞、岛叶患者最小8岁,最大52岁,平均(20.2±8.5)岁;男性138例(69.7%),女性60例(30.3%),平均(10.8±0.7)根/例;单侧置入141例(71.2%),双侧置入57例(28.8%),其中2例补充电极(共7根)。有3例患者出现血肿,2例行急诊手术治疗,4例患者出现少量蛛网膜下腔出血,未出现明显临床症状,2例患者因癫痫发作后出现电极折断一根。无一例出现死亡、感染、脑脊液漏等。电极最大误差为5.2 mm,最小误差为0,平均误差在2.1 mm。196例颞、岛叶癫痫患者行手术切除,2例未手术,术后随访时间6~75个月。EngelⅠ级152例(78.7%)、Ⅱ级27例(14%)、Ⅲ级9例(4.7%)、Ⅳ级5例(2.6%),其中3例失访。结论立体脑电图是一种有效和相对安全的微创手术,对涉及血管丰富及部分结构位置深在的颞叶内侧、岛叶难治性癫痫具有重要诊疗价值,熟练掌握置入技术可以减少术后并发症的发生。

Objective:To explore the safety and effectiveness of stereoelectroencephalogram(SEEG)in the diagnosis and treatment of drug refractory epilepsy in temporal and insular lobes.Methods The clinical data of patients who underwent SEEG electrode implantation at the Epilepsy Center of Guangdong Sanjiu Brain Hospital from September 2014 to December 2020 were analyzed retrospectively.All patients underwent a detailed preoperative non-invasive assessment(including recording of scalp electroencephalogram,brain magnetic resonance imaging,intermittent positron emission tomography-computer tomography,neuropsychological assessment,etc.),and ROSA robot was used to insert intracranial electrodes to monitor the interictal and electroencephalograms,record habitual seizures,and determine the origin of the epileptic focus and the location of the functional area based on the results of the intracranial electrode electroencephalogram during the attack before surgical resection.Results A total of 564 patients underwent SEEG electrode implantation,including 414 adults and 150 children.The total number of electrodes was 6190,including 198 patients with temporal and insular lobe SEEG electrodes implantation,with a total of 2147 electrodes.The temporal and insular lobe electrodes implantation patients had a minimum age of 8 years and a maximum age of 52 years,with an average age of(20.2±8.5)years.There were 138 males(69.7%)and 60 females(30.3%),with an average of(10.8±0.7)roots per case.141 cases(71.2%)were implanted unilaterally and 57 cases(28.8%)were implanted bilaterally,of which 2 cases were supplemented with electrodes(7 in total).Intracerebral hematoma occurred in 3 patients,emergency operation was performed in 2 patients,a small amount of subarachnoid hemorrhage occurred in 4 patients without obvious clinical symptoms,and one electrode was broken in 2 patients during seizure.No death,infection or cerebrospinal fluid leakage occurred.The maximum error of electrode was 5.2 mm,the minimum error was 0,and the average error was 2.1 mm.196 patients with temporal and insular lobe epilepsy underwent surgical resection and 2 cases were not operated.The postoperative follow-up time was 6-75 months.152 patients(78.7%)had Engel ClassⅠ,27(14%)had Engel ClassⅡ,9(4.7%)patients had Engel ClassⅢ,5(2.6%)patients had Engel ClassⅣ,3 patients were lost in follow-up.Conclusions SEEG is an effective and relatively safe minimally invasive procedure.It has important diagnostic and therapeutic value for intractable mesial temporal and insular lobe epilepsy which involving rich blood vessels and deep structures.Proficiently mastering the implantation technology can reduce the incidence of postoperative complications.