neurosurgeryНейрохирургияRussian journal of neurosurgery1683-32952587-7569Издательский дом "МедИНК"10.17650/1683-3295-2020-22-1-12-20neurosurgery-830Research ArticleОРИГИНАЛЬНАЯ РАБОТАORIGINAL REPORTВозможности хирургического лечения фармакорезистентной эпилепсии с использованием робот-ассистированной имплантации глубинных электродов для проведения инвазивной стереоэлектроэнцефалографииPossibilities for surgical treatment of the pharmacoresistant form of epilepsy using robot-assisted implantation of deep electrodes for invasive stereoelectroencephalographyhttps://orcid.org/0000-0003-2974-1462ЗуевА. А.ZuevA. A.

105203 Москва, ул. Нижняя Первомайская, 70

70 Nizhnyaya Pervomayskaya St., Moscow 105203

mosbrain@gmail.comhttps://orcid.org/0000-0001-6468-5350ГоловтеевА. Л.GolovteevA. L.

105118 Москва, ул. Бориса Жигуленкова, 7

7 Borisa Zhigulenkova St., Moscow 105118

https://orcid.org/0000-0002-2713-5904ПедяшН. В.PedyashN. V.

105203 Москва, ул. Нижняя Первомайская, 70

70 Nizhnyaya Pervomayskaya St., Moscow 105203

https://orcid.org/0000-0002-2899-0734КалыбаеваН. А.KalybaevaN. A.

105203 Москва, ул. Нижняя Первомайская, 70

70 Nizhnyaya Pervomayskaya St., Moscow 105203

https://orcid.org/0000-0002-2784-302XБроновО. Ю.BronovO. Yu.

105203 Москва, ул. Нижняя Первомайская, 70

70 Nizhnyaya Pervomayskaya St., Moscow 105203

ФГБУ «Национальный медико-хирургический центр им. Н. И. Пирогова» Минздрава РоссииРоссияN.I. Pirogov National Medical and Surgical Center, Ministry of Health of RussiaRussian FederationНеврологическая клиника Epilepsy CenterРоссияEpilepsy CenterRussian Federation2020110420202211220Copyright © Зуев А.А., Головтеев А.Л., Педяш Н.В., Калыбаева Н.А., Бронов О.Ю., 20202020Зуев А.А., Головтеев А.Л., Педяш Н.В., Калыбаева Н.А., Бронов О.Ю.Zuev A.A., Golovteev A.L., Pedyash N.V., Kalybaeva N.A., Bronov O.Y.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.therjn.com/jour/article/view/830

Цель исследования – определить эффективность и безопасность применения роботизированной навигационной системы при имплантации глубинных электродов для проведения инвазивной стереоэлектроэнцефалографии (стерео-ЭЭГ) у пациентов с фармакорезистентной эпилепсией.

Материалы и методы

Материалы и методы. В исследование включены 27 пациентов, которым в период с 2016 по 2018 г. имплантированы электроды с применением роботизированной навигационной системы. Односторонняя имплантация электродов была проведена в 22 случаях, двусторонняя – в 6 (у 1 пациента в связи с недостаточной эффективностью операции по удалению эпилептогенного очага имплантация проведена дважды). На 2-е сутки после имплантации начинали инвазивный видео-ЭЭГ-мониторинг. При магнитно-резонансной томографии изменения не выявлены у 16 (59 %) пациентов, обнаружены множественные структурные изменения у 11 (41 %). Средняя продолжительность инвазивного видео-ЭЭГ-мониторинга составила 96 ч (от 46 до 253 ч).

Результаты

Результаты. На основании информации, полученной при инвазивном мониторинге, верифицировано расположение зон начала приступа и раннего распространения активности: в височной доле – у 9 (33 %) пациентов, в лобной доле – у 6 (22 %), в теменной доле – 2 (8 %), в затылочной доле – 3 (11 %), в 2 и более долях – у 4 (15 %), в обоих полушариях – у 3 (11 %) пациентов. У 19 (70,4 %) пациентов выполнена резекция эпилептогенной зоны: экстратемпоральная – у 11 (58 %), переднемедиальная височная лоб- и амигдалгиппокампэктомия – у 8 (42 %). Катамнез собирали в течение 6 мес и более после удаления эпилептогенной зоны, выявленной при стерео-ЭЭГ, у 13 пациентов. Исходы хирургического лечения в этой группе были следующими: у 8 (61 %) пациентов соответствовали I классу по шкале J. Engel и соавт., у 1 (8 %) – II классу, у 3 (23 %) – III классу, у 1 (8 %) – IV классу.

Заключение

Заключение. Имплантация глубинных электродов с применением роботизированной навигационной системы – безопасный и эффективный вспомогательный метод, позволяющий провести инвазивный стерео-ЭЭГ-мониторинг для выявления эпилептогенных очагов у пациентов с фармакорезистентной эпилепсией. У пациентов с МРТ-негативной формой эпилепсии стерео-ЭЭГ дает возможность определить границы эпилептогенной зоны, тем самым увеличивая эффективность и безопасность ее резекции.

The study objective is to determine the effectiveness, safety and information content of robot-assisted implantation of deep electrodes for invasive stereoelectroencephalography (stereo-EEG) monitoring in patients with pharmacoresistant epilepsy.

Materials and methods

Materials and methods. The study group included 27 patients from 2016 and 2018, who underwent a robot-assisted implantation of stereo-EEG electrodes followed by a 24-hour video-EEG monitoring. Unilateral implantation of electrodes was performed in 22 patients, bilateral – in 6 patients (in 1 patient, due to the ineffectiveness of the operation to remove the epileptogenic focus, implantation was performed twice). MRI-negative epilepsy was in 16 (59 %) patients; 11 (41 %) patients with multiple structural changes. The average time for invasive video-EEG monitoring was 96 hours (from 46 to 253 hours).

Results

Results. Based on the information obtained during invasive monitoring, the epileptogenic zones and early distribution were verified: in the temporal lobe in 9 (33 %) patients, in the frontal lobe – 6 (22 %), in the parietal lobe – 2 (8 %), in the occipital lobe – 3 (11 %), in more than 2 lobes – 4 (15 %), in both hemispheres – 3 (11 %) patients. Nineteen (70.4 %) patients underwent surgery to remove the epileptogenic zone. In 11 (58 %) patients extratemporal resection was performed and 8 (42 %) patients underwent anterior-medial temporal and amygdal-hippocampectomy. Follow-up history of more than 6 months after removal of the epileptogenic zone detected by stereo-EEG was monitored in 13 patients. The outcomes of surgical resection were as follows: in 8 (61 %) patients – Engel I, in 1 (8 %) – Engel II, in 3 (23 %) – Engel III, in 1 (8 %) – Engel IV.

Conclusion

Conclusion. Robot-assisted implantation of deep electrodes for invasive stereo-EEG monitoring is a safe and effective diagnostic method in patients with pharmacoresistant epilepsy. In patients with MRI-negative epilepsy, stereo-EEG allows to localize and determine the boundaries of the epileptogenic zone, thereby increasing the effectiveness and safety of surgical resection.

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The authors declare that there are no conflicts of interest present.