Pediatric patients frequently require invasive exploration with intracranial electrodes to achieve high-resolution delineation of the epileptogenic zones (EZ). We intend to discuss the efficacy and safety of stereoelectroencephalophraphy (SEEG) monitoring in pediatric patients with difficulty to localize the EZ. We retrospectively analyzed presurgical findings, SEEG data, resections, and outcomes of a series of 72 consecutive pediatric patients (<18 yrs) who had medically refractory epilepsy and received SEEG recording between January 2015 and September 2019. There were 20 girls and 52 boys with a mean age of 10.13 ± 4.11 years old (range: 1.8-18 years). Twenty-seven patients (37.5%) had nonlesional magnetic resonance imagings (MRIs). In total, 744 electrodes were implanted for an average of 10.33 ± 2.53 (range: 3-18) electrodes per patient. Twenty-eight explorations were unilateral (17 left and 11 right), and 44 explorations were bilateral (12 of which was predominately one side). The average monitoring period in days for the SEEG was 8.99 ± 5.79 (range: 3-25) days. The EZ could be located in 67 (94.4%) patients for the initial implantation according to SEEG monitoring. Lobectomy was performed in 12 patients (17.9%), of those anterior temporal lobectomy (ATL) was performed in 8 cases (11.9%) and insular plus was 2 cases (3.0%), multilobectomy resections in 15 cases (22.4%), tailored cortical resections in 37 cases (55.2%), and corpus callosotomy plus in 2 cases (3.0%). The average follow-up was 18.1 ± 7.53 months (range: 6-54). Forty-three of 67 patients (64.2%) were Engel class I, 12 patients (17.9%) were Engel class II, 10 patients (14.9%) were Engel class III, and an additional 2 patients (3.0%) were Engel class IV. In the SEEG implantation series, no child experienced serious or permanent morbidity. One patient (1.4%) experienced symptomatic intracranial hemorrhage (ICH), and 3 patients (4.2%) experienced asymptomatic ICH. There were no postimplantation infections or other postoperative complications associated with the SEEG. Several common complications related to resection surgery were included in this series with zero mortality. Of the 6 patients in whom we performed a second surgery, 4 of them subsequently became seizure-free (66.7%) after undergoing the second resection with SEEG evaluation. Stereoelectroencephalophraphy is a safe and efficient methodology to identify the EZ in particularly complex cases of focal medically refractory epilepsy for pediatric patients, even in infancy and early childhood. Seizure outcomes of SEEG-guided resection surgery are desirable. We recommend SEEG evaluations and even a more aggressive resection in certain pediatric patients who failed initial resection with realistic chances to benefit from reoperation.

中文翻译：

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药物难治性小儿癫痫个体化立体脑电图评估和导航切除

儿科患者经常需要使用颅内电极进行侵入性探查，以实现癫痫发生区 (EZ) 的高分辨率描绘。我们打算讨论立体脑电 (SEEG) 监测对难以定位 EZ 的儿科患者的有效性和安全性。我们回顾性分析了 2015 年 1 月至 2019 年 9 月期间连续 72 名患有医学难治性癫痫并接受 SEEG 记录的儿科患者（<18 岁）的术前发现、SEEG 数据、切除术和结果。有 20 名女孩和 52 名男孩患有平均年龄为 10.13 ± 4.11 岁（范围：1.8-18 岁）。27 名患者 (37.5%) 进行了非病变磁共振成像 (MRI)。总共植入了 744 个电极，每位患者平均植入 10.33 ± 2.53（范围：3-18）个电极。单侧探查 28 次（左侧 17 次，右侧探查 11 次），双侧探查 44 次（其中 12 次以一侧为主）。SEEG 的平均监测天数为 8.99 ± 5.79（范围：3-25）天。根据 SEEG 监测，EZ 可定位于 67 (94.4%) 名患者的初始植入。12例患者（17.9%）进行了肺叶切除术，其中前颞叶切除术（ATL）8例（11.9%），岛叶加2例（3.0%），多叶切除术15例（22.4%），量身定制皮质切除37例（55.2%），胼胝体切除加2例（3.0%）。平均随访时间为 18.1 ± 7.53 个月（范围：6-54）。67例患者中有43例（64.2%）为Engel I级，12例（17.9%）为Engel II级，10例（14.9%）为Engel III级，另有 2 名患者 (3.0%) 为 Engel IV 级。在 SEEG 植入系列中，没有孩子出现严重或永久性的疾病。1 名患者 (1.4%) 出现症状性颅内出血 (ICH)，3 名患者 (4.2%) 出现无症状 ICH。没有与 SEEG 相关的植入后感染或其他术后并发症。该系列包括与切除手术相关的几种常见并发症，死亡率为零。在我们进行第二次手术的 6 名患者中，其中 4 名患者在接受第二次切除术并进行 SEEG 评估后随后无癫痫发作 (66.7%)。立体脑电图是一种安全有效的方法，用于在儿科患者的局灶性医学难治性癫痫特别复杂的病例中识别 EZ，即使在婴儿期和幼儿期。SEEG 引导的切除手术的癫痫发作结果是可取的。我们建议对初始切除失败的某些儿科患者进行 SEEG 评估，甚至更积极的切除，但仍有机会从再次手术中获益。