Object

Epilepsy surgery is an effective treatment for selected patients with focal intractable epilepsy. Complete removal of the epileptogenic zone significantly increases the chances for postoperative seizure-freedom. In complex surgical candidates, delineation of the epileptogenic zone requires a long-term invasive video/EEG from intracranial electrodes. It is especially challenging to achieve a complete resection in deep brain structures such as opercular-insular cortex. We report a novel approach utilizing intraoperative visual detection of stereotactically implanted depth electrodes to inform and guide the extent of surgical resection.

Methods

We retrospectively reviewed data of pediatric patients operated in Motol Epilepsy Center between October 2010 and June 2020 who underwent resections guided by intraoperative visual detection of depth electrodes following SEEG. The outcome in terms of seizure- and AED-freedom was assessed individually in each patient.

Results

Nineteen patients (age at surgery 2.9–18.6 years, median 13 years) were included in the study. The epileptogenic zone involved opercular-insular cortex in eighteen patients. The intraoperative detection of the electrodes was successful in seventeen patients and the surgery was regarded complete in sixteen. Thirteen patients were seizure-free at final follow-up including six drug-free cases. The successful intraoperative detection of the electrodes was associated with favorable outcome in terms of achieving complete resection and seizure-freedom in most cases. On the contrary, the patients in whom the procedure failed had poor postsurgical outcome.

Conclusion

The reported technique helps to achieve the complete resection in challenging patients with the epileptogenic zone in deep brain structures.

中文翻译：

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术中检测立体定向插入脑内电极能否提高癫痫切除术的精准度？

目的

癫痫手术是治疗局灶性难治性癫痫患者的有效方法。完全去除致痫区可显着增加术后无癫痫发作的机会。在复杂的手术候选人中，致痫区的描绘需要来自颅内电极的长期侵入性视频/脑电图。在脑深部结构（如岛叶-岛叶皮层）中实现完全切除尤其具有挑战性。我们报告了一种利用立体定向植入深度电极的术中视觉检测来通知和指导手术切除程度的新方法。

方法

我们回顾性审查了 2010 年 10 月至 2020 年 6 月期间在 Motol 癫痫中心手术的儿科患者的数据，这些患者在 SEEG 后在术中视觉检测深度电极的指导下接受了切除术。在无癫痫发作和无 AED 方面的结果在每位患者中单独评估。

结果

19 名患者（手术年龄为 2.9-18.6 岁，中位年龄为 13 岁）被纳入研究。致痫区涉及 18 名患者的岛叶-岛叶皮层。17 名患者的术中电极检测成功，16 名患者认为手术完成。13 名患者在最终随访时无癫痫发作，其中包括 6 名无药物病例。在大多数情况下，成功的术中电极检测与实现完全切除和无癫痫发作的良好结果相关。相反，手术失败的患者术后结果较差。

结论

所报告的技术有助于在具有深部脑结构致癫痫区的挑战性患者中实现完全切除。