Abstract：
BACKGROUND: Patients with medication-resistant disabling epilepsy should be considered for potential epilepsy surgery. If noninvasive techniques are unable to identify the location of the seizure onset zone (SOZ), it becomes necessary to consider intracranial investigations. Stereo-electroencephalography (SEEG) is currently the preferred method for such monitoring, however foramen ovale (FO) electrodes offer a less invasive alternative that may be suitable in certain situations. Previous studies have demonstrated the effectiveness of FO electrodes in suspected mesial temporal epilepsy, nevertheless, increased experience with FO electrode use could further enhance their safety and efficacy. Therefore, we conducted an analysis of recent FO electrode investigations to assess their utility in surgical decision making, post resection outcomes, and complication rates.
METHODS: We conducted a retrospective analysis of 61 patients who underwent FO placement at Mass General Brigham between 2009 and 2020. Patient and seizure characteristics, preoperative investigation data, and seizures outcomes were collected. In addition, identified predictors of FO utility using logistic regression.
RESULTS: A total of 61 patients were identified. FO evaluation localized the SOZ in 56 % of patients. Complications were encountered in 1.6 % of patients. Subsequent surgical resection was pursued by 49 % of patients, with 56 % becoming seizure free, and 67 % having favorable seizure outcomes at last follow-up. Multivariate analysis identified younger patients with a higher number of preoperative ASMs as more likely to undergo subsequent treatment, however, these features were not predictive features of SOZ localization, seizure freedom, or favorable seizure outcomes. In patients with bitemporal or cross-over onsets on scalp EEG, FO was able to identify the SOZ in 79 %, whereas in patients with discordant or unclear onset, the rates were 71 % and 45 %, respectively.
CONCLUSIONS: In a contemporary cohort, FO electrode placement had a low complication rate and a high utility primarily in cases of unclear laterality of mesial temporal onsets or discordance between scalp EEG and other pre-FO investigation data in cases of suspected mesial temporal onsets.
METHODS: We conducted a retrospective analysis of 61 patients who underwent FO placement at Mass General Brigham between 2009 and 2020. Patient and seizure characteristics, preoperative investigation data, and seizures outcomes were collected. In addition, identified predictors of FO utility using logistic regression.
RESULTS: A total of 61 patients were identified. FO evaluation localized the SOZ in 56 % of patients. Complications were encountered in 1.6 % of patients. Subsequent surgical resection was pursued by 49 % of patients, with 56 % becoming seizure free, and 67 % having favorable seizure outcomes at last follow-up. Multivariate analysis identified younger patients with a higher number of preoperative ASMs as more likely to undergo subsequent treatment, however, these features were not predictive features of SOZ localization, seizure freedom, or favorable seizure outcomes. In patients with bitemporal or cross-over onsets on scalp EEG, FO was able to identify the SOZ in 79 %, whereas in patients with discordant or unclear onset, the rates were 71 % and 45 %, respectively.
CONCLUSIONS: In a contemporary cohort, FO electrode placement had a low complication rate and a high utility primarily in cases of unclear laterality of mesial temporal onsets or discordance between scalp EEG and other pre-FO investigation data in cases of suspected mesial temporal onsets.
摘要：
背景：患有耐药致残性癫痫的患者应考虑进行潜在的癫痫手术。如果非侵入性技术无法识别癫痫发作区（SOZ）的位置，有必要考虑颅内检查。立体脑电图（SEEG）是目前这种监测的首选方法，然而卵圆孔（FO）电极提供了一种侵入性较小的替代方案，在某些情况下可能是合适的。先前的研究已经证明了FO电极在疑似内侧颞叶癫痫中的有效性，然而，增加使用FO电极的经验可以进一步提高其安全性和有效性。因此,我们对最近的FO电极研究进行了分析，以评估其在手术决策中的实用性，切除后结果,和并发症发生率。
方法：我们对2009年至2020年在MassGeneralBrigham接受FO安置的61例患者进行了回顾性分析。患者和癫痫发作特征，术前调查数据，并收集癫痫发作结果.此外,使用逻辑回归确定FO效用的预测因子。
结果：共确认61例患者。FO评估将SOZ定位在56%的患者中。1.6%的患者出现并发症。49%的患者追求随后的手术切除，56%的人没有癫痫发作，67%的患者在最后一次随访时获得了良好的癫痫发作结果。多因素分析发现，术前ASM数量较多的年轻患者更有可能接受后续治疗。然而,这些特征不是SOZ本地化的预测特征，癫痫发作自由，或有利的癫痫发作结果。在头皮脑电图上出现双时或交叉发作的患者中，FO能够识别79%的SOZ，而在发病不一致或不清楚的患者中，比率分别为71%和45%，分别。
结论：在当代队列中，FO电极放置的并发症发生率低，实用性高，主要是在内侧颞叶发作不清楚的情况下，或者在怀疑内侧颞叶发作的情况下，头皮EEG与其他前FO调查数据之间不一致。
方法：我们对2009年至2020年在MassGeneralBrigham接受FO安置的61例患者进行了回顾性分析。患者和癫痫发作特征，术前调查数据，并收集癫痫发作结果.此外,使用逻辑回归确定FO效用的预测因子。
结果：共确认61例患者。FO评估将SOZ定位在56%的患者中。1.6%的患者出现并发症。49%的患者追求随后的手术切除，56%的人没有癫痫发作，67%的患者在最后一次随访时获得了良好的癫痫发作结果。多因素分析发现，术前ASM数量较多的年轻患者更有可能接受后续治疗。然而,这些特征不是SOZ本地化的预测特征，癫痫发作自由，或有利的癫痫发作结果。在头皮脑电图上出现双时或交叉发作的患者中，FO能够识别79%的SOZ，而在发病不一致或不清楚的患者中，比率分别为71%和45%，分别。
结论：在当代队列中，FO电极放置的并发症发生率低，实用性高，主要是在内侧颞叶发作不清楚的情况下，或者在怀疑内侧颞叶发作的情况下，头皮EEG与其他前FO调查数据之间不一致。
