对于药物难治性癫痫患者,颅内电极监测可以帮助识别癫痫灶。尽管立体脑电图(SEEG)的应用越来越多,与传统硬膜下电极监测(SDE)相比,与该技术相关的相对风险或益处尚不清楚,尤其是在儿科人群中。我们的目的是比较接受SEEG或SDE(网格和条带)颅内监测的儿科患者的结局。
我们回顾性研究了2014年至2017年在我们机构进行的38例连续儿科颅内电极监测病例。回顾病史/手术史和手术/术后记录。我们还比较了与这两种程序相关的直接住院费用。
立体脑电图和SDE队列均显示出很高的识别癫痫区的可能性(SEEG:90.9%,SDE:87.5%)。与SDE相比,SEEG患者的手术时间明显较短(118.7对233.4分钟,P<.001)和住院时间(6.2天和12.3天,P<.001),包括在重症监护病房度过的天数(ICU;1.4天与5.4天,P<.001)。立体脑电图患者倾向于报告较低的疼痛评分,并且使用的麻醉止痛药明显较少(54.2对197.3mg吗啡当量,P=.005)。未观察到并发症。立体脑电图和SDE队列的住院费用相当(P=0.47)。
与硬膜下电极放置相比,SEEG导致类似的良好临床结果,但是手术时间减少了,减少麻醉剂的使用,和卓越的疼痛控制,而不需要明显更高的成本。改善术后颅内电极监测经验的潜力使SEEG特别适合儿科患者。
For patients with medically refractory epilepsy, intracranial electrode monitoring can help identify epileptogenic foci. Despite the increasing utilization of stereoelectroencephalography (SEEG), the relative risks or benefits associated with the technique when compared with the traditional subdural electrode monitoring (SDE) remain unclear, especially in the pediatric population. Our aim was to compare the outcomes of pediatric patients who received intracranial monitoring with SEEG or SDE (grids and strips).
We retrospectively studied 38 consecutive pediatric intracranial electrode monitoring cases performed at our institution from 2014 to 2017. Medical/surgical history and operative/postoperative records were reviewed. We also compared direct inpatient hospital costs associated with the two procedures.
Stereoelectroencephalography and SDE cohorts both showed high likelihood of identifying epileptogenic zones (SEEG: 90.9%, SDE: 87.5%). Compared with SDE, SEEG patients had a significantly shorter operative time (118.7 versus 233.4 min, P < .001) and length of stay (6.2 versus 12.3 days, P < .001), including days spent in the intensive care unit (ICU; 1.4 versus 5.4 days, P < .001). Stereoelectroencephalography patients tended to report lower pain scores and used significantly less narcotic pain medications (54.2 versus 197.3 mg morphine equivalents, P = .005). No complications were observed. Stereoelectroencephalography and SDE cohorts had comparable inpatient hospital costs (P = .47).
In comparison with subdural electrode placement, SEEG results in a similarly favorable clinical outcome, but with reduced operative time, decreased narcotic usage, and superior pain control without requiring significantly higher costs. The potential for an improved postoperative intracranial electrode monitoring experience makes SEEG especially suitable for pediatric patients.