Artikel
Decision making in temporal lobe epilepsy surgery based on invasive stereoelectroencephalography (sEEG)
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Autoren
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Lasse Dührsen
- Universitätsklinikum Hamburg-Eppendorf, Klinik für Neurochirurgie, Hamburg, Deutschland
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Thomas Sauvigny
- Universitätsklinikum Hamburg-Eppendorf, Klinik für Neurochirurgie, Hamburg, Deutschland
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Wolfgang Hamel
- Universitätsklinikum Hamburg-Eppendorf, Klinik für Neurochirurgie, Hamburg, Deutschland
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Jonas Hebel
- Evangelisches Krankenhaus Alsterdorf, Epilepsiezentrum Hamburg, Hamburg, Deutschland
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Manfred Westphal
- Universitätsklinikum Hamburg-Eppendorf, Klinik für Neurochirurgie, Hamburg, Deutschland
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Michael Lanz
- Evangelisches Krankenhaus Alsterdorf, Epilepsiezentrum Hamburg, Hamburg, Deutschland
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Tobias Martens
- Universitätsklinikum Hamburg-Eppendorf, Klinik für Neurochirurgie, Hamburg, Deutschland
| Veröffentlicht: | 18. Juni 2018 |
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Gliederung
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Objective: In medical refractory temporal lobe epilepsy (TLE), especially in the absence of clear MRI pathologies and non-specific results from presurgical evaluation, the seizure focus can be difficult to find and thereby difficult to treat. Invasive monitoring with stereoelectroencephalography (sEEG) is a tool for better determination of the seizure zone. Here we investigate the impact of sEEG on decision making in temporal lobe epilepsy surgery.
Results: From 2013-2017 we performed 152 temporal resections in epilepsy patients. 20 of those patients were designated for further investigation with sEEG due to incongruent findings in presurgical evaluation. Patients received between 4 and 9 electrodes placed in the anterior and dorsal hippocampus, temporal lobe and insula. Six patients were implanted bitemporally. No intracerebral bleedings or infections occurred. In five cases the hypothesis for the seizure onset and localization had to be changed due to sEEG findings and resulted in a different tailored resection than planned. In three cases sEEG findings led to cancelation of the originally planned temporal resection as the epileptogenic zone was not definable or bilateral. In another three cases the prognosis for reduction of seizures postoperatively had to be reduced due to the sEEG findings. However, the resection was performed after interdisciplinary discussion and informed consent of the patient. The examination by sEEG led to a change of plan for further treatment in 12 patients (60 %) suffering TLE in total.
Conclusion: Invasive monitoring with sEEG-electrodes had a strong impact on decision making for further treatment in patients suffering from temporal lobe epilepsy designated for epilepsy surgery. This applies to resection volumes as much as to prediction of seizure outcome.
