癫痫的侵袭性术前评估_Journal of Epilepsy

Authors：

李承俊 ¹ ,  林元相 ²

1. ;
2. ;

Corresponding author：

林元相, Email: lyx99070@163.com

Keywords：

难治性癫痫; SEEG; 硬膜下电极; 致痫灶

DOI：

10.7507/2096-0247.20200009

Video：

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癫痫切除手术前精确定位致痫灶至关重要，目前，对于综合无创性评估仍无法定位致痫灶或区分功能区的患者，国际上常采用硬膜下电极脑电图监测（Subduralel ectrodes EEG, SDEG）和立体定向脑电图（SEEG）两种侵袭性颅内脑电图（intracranial electroencephalography, iEEG）评估方法进一步定位致痫灶及区分功能区。SDEG 优势在于其相邻皮质覆盖连续性较好、皮层与电极的解剖关系清楚以及功能区定位相对容易；缺点主要在于对深部脑组织覆盖监测较差、癫痫起源的三维结构难以体现、双侧或相隔较远的多个区域植入困难以及创伤较大、并发症比例较高。SEEG 的优点在于定位深部皮质相对容易、癫痫起源的三维结构清楚、微创性高、适合双侧或相隔较远的多个区域植入；缺点在于相邻皮质覆盖连续性较差、功能区定位相对困难、植入过程中可损伤颅内血管导致颅内出血。近年来，iEEG 监测快速发展，但仍需进一步探索，如通过技术的不断改进及创新实现精确植入电极及降低植入并发症，通过设计临床前瞻性研究进一步研究 SDEG 和 SEEG 在定位致痫灶、切除范围及术后疗效的差异等。目前，SDEG 和 SEEG 在术前定位致痫灶方面各有优缺点，临床上应根据患者的具体情况个体化选择方案。

Citation： 李承俊, 林元相. 癫痫的侵袭性术前评估. Journal of Epilepsy, 2020, 6(1): 44-48. doi: 10.7507/2096-0247.20200009 Copy

1.	Kwan P, Arzimanoglou A, Berg AT, et al. Definition of drug resistant epilepsy:consensus proposal by the ad hoc Task Force of the ILAE Commission on TherapeuticStrategies. Epilepsia, 2010, 51(6): 1069-1077.
2.	Sheng J, Liu S, Qin H, et al. Drug-Resistant Epilepsy and Surgery. Curr Neuropharmacol, 2018, 16(1): 17-28.
3.	Irimia A, Van Horn JD. Epileptogenic focus localization in treatment-resistant post- traumatic epilepsy. J Clin Neurosci, 2015, 22(4): 627-631.
4.	Iwasaki M, Jin K, Nakasato N, et al. Non-invasive Evaluation for Epilepsy Surgery. Neurol Med Chir (Tokyo), 2016, 56(10): 632-640.
5.	Sevy A, Gavaret M, Trebuchon A, et al. Beyond the lesion:the epileptogenic-networ- ks around cavernous angiomas. Epilepsy Res, 2014, 108(4): 701-708.
6.	Jehi LE, Palmini A, Aryal U, et al. Cerebral cavernous malformati-ons in the setting of focal epilepsies: pathological findings, clinical characteristics, and surgical treatment principles. Acta Neuropathol, 2014, 128(1): 55-65.
7.	Hupalo M, Wojcik R, Jaskolski DJ. Intracranial video-EEG monitoring in presurgical evaluation of patients with refractory epilepsy. Neurol Neurochir Pol, 2017, 51(3): 201-207.
8.	Katz JS, Abel TJ. Stereoelectroencephalography Versus Subdural Electrodes for Loc- alization of the Epileptogenic Zone:What Is the Evidence? Neurotherapeutics, 2019, 16(1): 59-66.
9.	ashima R, Jin K, Nakasato N, et al. Electro- and magneto-encephalographic spike source localization of small focal cortical dysplasia in the dorsal peri-rolandicregion. Clin Neurophysiol, 2014, 125(12): 2358-2363.
10.	Itabashi H, Jin K, Iwasaki M, et al. Preoperative MRI predicts outcome of temporal lobectomy: an actuarial analysis. Neurology, 1995, 45(7): 1358-1363.
11.	Lüders HO, Najm I, Nair D, et al. The epileptogenic zone:general principles. Epileptic Disord, 2008, 10(2): 191-199.
12.	Ramantani G, Maillard L, Koessler L. Correlation of invasive EEG and scalp EEG. Seizure, 2016, 41: 196-200.
13.	Kovac S, Scott CA, Maglajlija V, et al. Extraoperative electrical cortical stimulation: characteristics of motor responses and correlation with precentral gyrus. J Clin Neurophysiol, 2011, 28(6): 618-624.
14.	Zea Vera A, Aungaroon G, Horn PS, et al. Language and motor function thresholds during pediatric extra-operative electrical cortical stimulation brain mapping. Clin Neurophysiol, 2017, 128(10): 2087-2093.
15.	Chaudhary UJ, Duncan JS. Applications of blood-oxygen- level- dependent func- tional magnetic resonance imaging and diffusion tensor imaging in epilepsy. Neuroimaging Clin N Am, 2014, 24(4): 671-694.
16.	Papanicolaou AC, Rezaie R, Narayana S, et al. Is it time to replace the Wada test and put awake craniotomy to sleep? Epilepsia, 2014, 55(5): 629-632.
17.	Almeida AN, Martinez V, Feindel W. The first case of invasive EEG monitoring for the surgical treatment of epilepsy: historical significance and context. Epilepsia, 2005, 46(7): 1082-1085.
18.	Reif PS, Strzelczyk A, Rosenow F. The history of invasive EEG evaluation in epilepsy patients. Seizure, 2016, 41: 191-195.
19.	Arya R, Mangano FT, Horn PS, et al. Adverse eventsrelated to extraoperative invasive EEG monitoring with subdural gridelectrodes: a systematic review and meta-analysis. Epilepsia, 2013, 54(5): 828-839.
20.	Kahane P, Landré E, Minotti L, et al. The Bancaud andTalairach view on the epileptogenic zone: a working hypothesis. Epileptic Disord, 2006, 8(2): 16-26.
21.	Kovac S, Kahane P, Diehl B. Seizures induced by direct electrical corticalstimulation-Mechanisms and clinical considerations. Clin Neurophysiol, 2016, 127(1): 31-39.
22.	]Mullin JP, Shriver M, Alomar S, et al. Is SEEG safe? A systematic review and meta-analysis of stereoelectroencephalography related complications. Epilepsia, 2016, 57(3): 386-401.
23.	Minotti L, Montavont A, Scholly J, et al. Indications and limits of stereoelectroencephalography (SEEG). Neurophysiol Clin, 2018, 48(1): 15-24.
24.	Kovac S, Scott CA, Maglajlija V, et al. Comparison of bipolar versus monopolar extraoperative electricalcortic- al stimulation mapping in patients with focal epilepsy. Clin Neurophysiol, 2014, 125(4): 667-674.
25.	Zhang X, Zhang G, Yu T, et al. Surgical treatmentfor epilepsy involving language cortices: a combined process of electricalcortical stimulation mapping and intra-operative continuous language assessment. Seizure, 2013, 22(9): 780-786.
26.	Kovac S, Rodionov R, Chinnasami S, et al. Clinical significance of nonhabitual seizures during intracranial EEG monitoring. Epilepsia, 2014, 55(1): 1-5.
27.	Kahane P, Tassi L, Francione S, et al. Electroclinical manifestations elicited by intracerebral electric stimulation"shocks" in temporal lobe epilepsy. Neurophysiol Clin, 1993, 23(4): 305-326.
28.	Nowell M, Sparks R, Zombori G, et al. Comparison of computer-assisted planning and manual planning for depth electrode implantations in epilepsy. J Neurosurg, 2016, 124(6): 1820-1828.
29.	Nowell M, Rodionov R, Zombori G, et al. Utility of 3Dmultimodality imaging in the implantation of intracranial electrodes in epilepsy. Epilepsia, 2015, 56(3): 403-413.
30.	González-Martínez J, Bulacio J, Thompson S, et al. Technique, Results, and Complications Related to Robot-Assisted Stereoelectroencephalography. Neurosurgery, 2016, 78(2): 169-180.
31.	Andrzejak RG, David O, Gnatkovsky V, et al. Localization of Epileptogenic Zone on Pre-surgical Intracranial EEG Recordings: Toward a Validation of QuantitativeSignal Analysis Approaches. Brain Topogr, 2015, 28(6): 832-837.
32.	Aubert S, Wendling F, Regis J, et al. Local and remote epileptogenicity in focal cortical dysplasias and neurodevelopmental tumours. Brain, 2009, 132(11): 3072-3086.
33.	Gnatkovsky V, Francione S, Cardinale F, et al. Identification of reproducible ictal patterns based on quantified frequency analysis of intracranial EEG signals. Epilepsia, 2011, 52(3): 477-488.
34.	Gollwitzer S, Valente I, Rodionov R, et al. Visual and semiautomated evaluation of epileptogenicity in focal cortical dysplasias - An intracranial EEG study. Epilepsy Behav, 2016, 58: 69-75.
35.	Jacobs J, Zijlmans M, Zelmann R, et al. High-frequency electroencephalographic oscillations correlate with outcome of epilepsy surgery. Ann Neurol, 2010, 67(2): 209-220.
36.	Höller Y, Kutil R, Klaffenböck L, et al. High-frequency oscillations in epilepsy and surgical outcome. A meta-analysis. Front Hum Neurosci, 2015, 9(574): 1-14.

1. Kwan P, Arzimanoglou A, Berg AT, et al. Definition of drug resistant epilepsy:consensus proposal by the ad hoc Task Force of the ILAE Commission on TherapeuticStrategies. Epilepsia, 2010, 51(6): 1069-1077.
2. Sheng J, Liu S, Qin H, et al. Drug-Resistant Epilepsy and Surgery. Curr Neuropharmacol, 2018, 16(1): 17-28.
3. Irimia A, Van Horn JD. Epileptogenic focus localization in treatment-resistant post- traumatic epilepsy. J Clin Neurosci, 2015, 22(4): 627-631.
4. Iwasaki M, Jin K, Nakasato N, et al. Non-invasive Evaluation for Epilepsy Surgery. Neurol Med Chir (Tokyo), 2016, 56(10): 632-640.
5. Sevy A, Gavaret M, Trebuchon A, et al. Beyond the lesion:the epileptogenic-networ- ks around cavernous angiomas. Epilepsy Res, 2014, 108(4): 701-708.
6. Jehi LE, Palmini A, Aryal U, et al. Cerebral cavernous malformati-ons in the setting of focal epilepsies: pathological findings, clinical characteristics, and surgical treatment principles. Acta Neuropathol, 2014, 128(1): 55-65.
7. Hupalo M, Wojcik R, Jaskolski DJ. Intracranial video-EEG monitoring in presurgical evaluation of patients with refractory epilepsy. Neurol Neurochir Pol, 2017, 51(3): 201-207.
8. Katz JS, Abel TJ. Stereoelectroencephalography Versus Subdural Electrodes for Loc- alization of the Epileptogenic Zone:What Is the Evidence? Neurotherapeutics, 2019, 16(1): 59-66.
9. ashima R, Jin K, Nakasato N, et al. Electro- and magneto-encephalographic spike source localization of small focal cortical dysplasia in the dorsal peri-rolandicregion. Clin Neurophysiol, 2014, 125(12): 2358-2363.
10. Itabashi H, Jin K, Iwasaki M, et al. Preoperative MRI predicts outcome of temporal lobectomy: an actuarial analysis. Neurology, 1995, 45(7): 1358-1363.
11. Lüders HO, Najm I, Nair D, et al. The epileptogenic zone:general principles. Epileptic Disord, 2008, 10(2): 191-199.
12. Ramantani G, Maillard L, Koessler L. Correlation of invasive EEG and scalp EEG. Seizure, 2016, 41: 196-200.
13. Kovac S, Scott CA, Maglajlija V, et al. Extraoperative electrical cortical stimulation: characteristics of motor responses and correlation with precentral gyrus. J Clin Neurophysiol, 2011, 28(6): 618-624.
14. Zea Vera A, Aungaroon G, Horn PS, et al. Language and motor function thresholds during pediatric extra-operative electrical cortical stimulation brain mapping. Clin Neurophysiol, 2017, 128(10): 2087-2093.
15. Chaudhary UJ, Duncan JS. Applications of blood-oxygen- level- dependent func- tional magnetic resonance imaging and diffusion tensor imaging in epilepsy. Neuroimaging Clin N Am, 2014, 24(4): 671-694.
16. Papanicolaou AC, Rezaie R, Narayana S, et al. Is it time to replace the Wada test and put awake craniotomy to sleep? Epilepsia, 2014, 55(5): 629-632.
17. Almeida AN, Martinez V, Feindel W. The first case of invasive EEG monitoring for the surgical treatment of epilepsy: historical significance and context. Epilepsia, 2005, 46(7): 1082-1085.
18. Reif PS, Strzelczyk A, Rosenow F. The history of invasive EEG evaluation in epilepsy patients. Seizure, 2016, 41: 191-195.
19. Arya R, Mangano FT, Horn PS, et al. Adverse eventsrelated to extraoperative invasive EEG monitoring with subdural gridelectrodes: a systematic review and meta-analysis. Epilepsia, 2013, 54(5): 828-839.
20. Kahane P, Landré E, Minotti L, et al. The Bancaud andTalairach view on the epileptogenic zone: a working hypothesis. Epileptic Disord, 2006, 8(2): 16-26.
21. Kovac S, Kahane P, Diehl B. Seizures induced by direct electrical corticalstimulation-Mechanisms and clinical considerations. Clin Neurophysiol, 2016, 127(1): 31-39.
22. ]Mullin JP, Shriver M, Alomar S, et al. Is SEEG safe? A systematic review and meta-analysis of stereoelectroencephalography related complications. Epilepsia, 2016, 57(3): 386-401.
23. Minotti L, Montavont A, Scholly J, et al. Indications and limits of stereoelectroencephalography (SEEG). Neurophysiol Clin, 2018, 48(1): 15-24.
24. Kovac S, Scott CA, Maglajlija V, et al. Comparison of bipolar versus monopolar extraoperative electricalcortic- al stimulation mapping in patients with focal epilepsy. Clin Neurophysiol, 2014, 125(4): 667-674.
25. Zhang X, Zhang G, Yu T, et al. Surgical treatmentfor epilepsy involving language cortices: a combined process of electricalcortical stimulation mapping and intra-operative continuous language assessment. Seizure, 2013, 22(9): 780-786.
26. Kovac S, Rodionov R, Chinnasami S, et al. Clinical significance of nonhabitual seizures during intracranial EEG monitoring. Epilepsia, 2014, 55(1): 1-5.
27. Kahane P, Tassi L, Francione S, et al. Electroclinical manifestations elicited by intracerebral electric stimulation"shocks" in temporal lobe epilepsy. Neurophysiol Clin, 1993, 23(4): 305-326.
28. Nowell M, Sparks R, Zombori G, et al. Comparison of computer-assisted planning and manual planning for depth electrode implantations in epilepsy. J Neurosurg, 2016, 124(6): 1820-1828.
29. Nowell M, Rodionov R, Zombori G, et al. Utility of 3Dmultimodality imaging in the implantation of intracranial electrodes in epilepsy. Epilepsia, 2015, 56(3): 403-413.
30. González-Martínez J, Bulacio J, Thompson S, et al. Technique, Results, and Complications Related to Robot-Assisted Stereoelectroencephalography. Neurosurgery, 2016, 78(2): 169-180.
31. Andrzejak RG, David O, Gnatkovsky V, et al. Localization of Epileptogenic Zone on Pre-surgical Intracranial EEG Recordings: Toward a Validation of QuantitativeSignal Analysis Approaches. Brain Topogr, 2015, 28(6): 832-837.
32. Aubert S, Wendling F, Regis J, et al. Local and remote epileptogenicity in focal cortical dysplasias and neurodevelopmental tumours. Brain, 2009, 132(11): 3072-3086.
33. Gnatkovsky V, Francione S, Cardinale F, et al. Identification of reproducible ictal patterns based on quantified frequency analysis of intracranial EEG signals. Epilepsia, 2011, 52(3): 477-488.
34. Gollwitzer S, Valente I, Rodionov R, et al. Visual and semiautomated evaluation of epileptogenicity in focal cortical dysplasias - An intracranial EEG study. Epilepsy Behav, 2016, 58: 69-75.
35. Jacobs J, Zijlmans M, Zelmann R, et al. High-frequency electroencephalographic oscillations correlate with outcome of epilepsy surgery. Ann Neurol, 2010, 67(2): 209-220.
36. Höller Y, Kutil R, Klaffenböck L, et al. High-frequency oscillations in epilepsy and surgical outcome. A meta-analysis. Front Hum Neurosci, 2015, 9(574): 1-14.

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