PDF(Pubmed)
Abstract：
BACKGROUND: The authors present a 50-year-old female with high-grade glioma involving the motor cortex as the cause of her drug-resistant epilepsy (DRE). Responsive neurostimulation (RNS) was chosen for epilepsy treatment. Due to concerns regarding the generator impeding the regular imaging surveillance required for treatment and monitoring of her glioma, surgeons placed the internal pulse generator (IPG) within an infraclavicular chest pocket.
METHODS: Implantation of the RNS device and IPG within the infraclavicular pocket was uneventful. However, both subdural and depth electrodes were used and connected to the IPG, and subdural electrodes are considerably shorter than depth electrodes (37 vs 44 cm). The shorter strip leads presumably generated significant tension, leading to fracture of the leads. Therefore, surgery was repeated using only depth electrodes for more length and less tension. The device has good-quality electrocorticography signals that continue to be used for device programming. The seizure burden was reduced, and quality of life improved for the patient.
CONCLUSIONS: The RNS system with infraclavicular IPG placement reduced the seizure burden and improved the quality of life of a patient with glioma-associated epilepsy. Surgeons may consider the infraclavicular location as an alternative site for implantation for RNS candidates who require recurrent intracranial magnetic resonance imaging.
METHODS: Implantation of the RNS device and IPG within the infraclavicular pocket was uneventful. However, both subdural and depth electrodes were used and connected to the IPG, and subdural electrodes are considerably shorter than depth electrodes (37 vs 44 cm). The shorter strip leads presumably generated significant tension, leading to fracture of the leads. Therefore, surgery was repeated using only depth electrodes for more length and less tension. The device has good-quality electrocorticography signals that continue to be used for device programming. The seizure burden was reduced, and quality of life improved for the patient.
CONCLUSIONS: The RNS system with infraclavicular IPG placement reduced the seizure burden and improved the quality of life of a patient with glioma-associated epilepsy. Surgeons may consider the infraclavicular location as an alternative site for implantation for RNS candidates who require recurrent intracranial magnetic resonance imaging.
摘要：
背景：作者介绍了一名50岁的女性，患有累及运动皮质的高级别神经胶质瘤是其耐药性癫痫（DRE）的原因。选择响应性神经刺激（RNS）用于癫痫治疗。由于担心发生器会阻碍治疗和监测神经胶质瘤所需的定期影像学监测，外科医生将内部脉冲发生器（IPG）放置在锁骨下胸袋内。
方法：在锁骨下袋内植入RNS装置和IPG是顺利的。然而,使用硬膜下电极和深度电极并连接到IPG，硬膜下电极比深度电极短得多（37对44厘米）。较短的带状引线可能会产生明显的张力，导致引线断裂。因此,仅使用深度电极重复手术，以获得更大的长度和更小的张力。该设备具有高质量的皮质电描记信号，可继续用于设备编程。缉获负担减轻了,改善了患者的生活质量。
结论：RNS系统与锁骨下IPG放置减轻了癫痫发作负担并改善了神经胶质瘤相关癫痫患者的生活质量。外科医生可能会考虑将锁骨下位置作为需要复发性颅内磁共振成像的RNS候选人的替代植入部位。
方法：在锁骨下袋内植入RNS装置和IPG是顺利的。然而,使用硬膜下电极和深度电极并连接到IPG，硬膜下电极比深度电极短得多（37对44厘米）。较短的带状引线可能会产生明显的张力，导致引线断裂。因此,仅使用深度电极重复手术，以获得更大的长度和更小的张力。该设备具有高质量的皮质电描记信号，可继续用于设备编程。缉获负担减轻了,改善了患者的生活质量。
结论：RNS系统与锁骨下IPG放置减轻了癫痫发作负担并改善了神经胶质瘤相关癫痫患者的生活质量。外科医生可能会考虑将锁骨下位置作为需要复发性颅内磁共振成像的RNS候选人的替代植入部位。
