Application of stereoelectroencephalography under image-navigation to surgery for frontal lobe epilepsy

KE Yanyan; ZHANG Chunqing; SHI Xianjun; AN Ning; HOU Zhi

doi:10.13798/j.issn.1009-153X.2019.09.001

Abstract：To explore the role of stereoelectroencephalography (SEEG) monitoring guided by image navigation in the surgery for frontal lobe epilepsy. Methods It was difficult to localize the epileptic focuses in 35 patients with front lobe epilepsy treated in our department from January, 2014 to March, 2016. The patients'brain MRI images were fused into Medtronic S7 navigation system and the stereotactic electrodes were implanted into the brains under the image-navigation. The epileptogenic zone was localized according to SEEG monitoring and resected by surgery. Postoperative follow-up time ranged from 1 to 3 years and the effects of epileptic control were evaluated by Engel's classification. Results The deep electrodes were implanted according to the peroperative plan in 35 patients, of whom, 12 received the unilateral implantations of electrodes and 23 bilateral implantations. The clinical usual attacks were detected in all the patients and the number of the attacks ranged from 3 to 20 times. After comprehensive assessment, the surgery was not performed in a patient because the epileptic focus was difficult of localization, and the epileptic focuses were successfully resected in the rest 34 patients according to the assessment results. After electrodes implantation, one patient had epidural hematoma of 20 ml which was removed by the surgery. After the surgery, one patient had transient unilateral paralysis in the early stage and one had motor aphasia which was cured by the treatment. The effect of epileptic control was Engel's classⅠin 24 patients (70.5%), classⅡin 5 (14.7%), classⅢ in 4 (11.7% ) and Ⅳ in 1 (2.9% ). Conclusion It is safe and effective to apply SEEG under image-navigation to location of the epileptic lesions in the patients with frontal lobe epilepsy.