The contribution of sphenoidal electrodes placed under fluoroscopy in lateralization of bilateral refractory temporal lobe epilepsy: a clinical study

Aşiyan Kilit; Gönül Güvenç; Sabiha Türe

doi:10.19161/etd.699273

TR EN

Floroskopi eşliğinde yerleştirilen sfenoidal elektrotların bilateral dirençli temporal lob epilepsisinde lateralizasyona olan katkısı: klinik çalışma

Öz

Amaç: Bu çalışma bilateral temporal lob epilepsisinde temporal iktal başlangıçların lateralizasyonunun saptanmasında, floroskopi eşliğinde yerleştirilen sfenoidal elektrotların saçlı deri elektrotlara katkısını değerlendirmek amacıyla yapıldı. Aynı zamanda bilgisayarlı tomografi ile sfenoidal elektrotların foramen ovaleye yakınlığı değerlendirildi.

Gereç ve Yöntem: 2010-2012 tarihleri arasında dirençli epilepsi tanısı olan, sfenoidal elektrot taktığımız 10 hastanın prospektif çalışmasını yaptık. Dirençli temporal lob epilepsisi tanısı almış ancak skalp EEG ile epileptik odak lokalizasyonu ve lateralizasyonu yapılamamış ya da video-EEG de bitemporal nöbet aktivitesi saptanarak bitemporal epilepsi tanısı almış ancak nöbet başlangıcı saptanamayan olgular değerlendirildi. Sfenoidal elektrotlar sedasyon altında ameliyathenede çift taraflı olarak takıldı. Sfenoidal elektrotların son pozisyonu ve birçok parametre 3D tomografide değerlendirildi. Hastalar video-EEG ünitesinde monitörize edildi. Eş zamanlı sfenoidal elektrot ve saçlı deri elektrot kayıtları alındı. Sfenoidal elektrot lateralizasyon sonuçları MR, PET ve saçlı deri EEG lateralizasyonu ile karşılaştırıldı.

Bulgular: Sfenoidal elektrotların yararlılık oranı %28,1 olarak saptandı. Lateralizasyonu yapılamamış 10 olgunun ikisi lokalize, sekiz olgunun dördü lateralize edilmiştir.

Sonuç: Literatürde sfenoidal elektrotların kullanımı ve yararlılıkları hakkında yapılan en önemli eleştiri, sfenoidal elektrotların faydasını saptayabilecek kadar hasta sayısının olmamasıdır. Daha fazla hasta sayısı ile prospektif çalışma yürütmek hangi hastanın sfenoidal elektrotlardan yararlanabileceğini tanımlamada faydalı olacaktır.

Anahtar Kelimeler

Sfenoidal elektrot,dirençli epilepsi,epilepsi cerrahisi.

The contribution of sphenoidal electrodes placed under fluoroscopy in lateralization of bilateral refractory temporal lobe epilepsy: a clinical study

Abstract

Aim: The aim of this study is to investigate the contribution of sphenoidal electrodes placed under fluoroscopic guidance to scalp electrodes, in the lateralization of temporal ictal onsets in bilateral refractory temporal lobe epilepsy. Also we determine the actual locations of sphenoidal electrodes by computerized tomography.

Materials and Methods: We performed a prospective study on 10 patients with intractable epilepsy who has underwent sphenoidal electrode placement from 2010 to 2012. Refractory temporal lobe epilepsy patients whose localization and lateralization of epileptic focus couldn’t established with scalp EEG, or patients diagnosed bitemporal epilepsy with bitemporal seizure activity in video-EEG but no seizure onset identified, were evaluated. Sphenoidal electrodes placed double-sided to patients under sedation in the operating room. The control of the sphenoidal electrodes’ last position and several parameters displayed with 3D tomography. Patients monitorized at video-EEG unit. Simultaneously sphenoidal electrodes and scalp electrodes recordings obtained. Sphenoidal electrode lateralization results are compared with MRI, PET, SCALP EEG lateralization.

Results: The utility rate of sphenoidal electrode recordings were found to be 28.1%. 2 of 10 cases lateralized were localized, 4 of 8 patients were lateralized by sphenoidal electrodes.

Conclusion: Sphenoidal electrodes and scalp electrodes are similar in their ability to detect seizures. The optimal placement of sphenoidal electrodes with our technique provided additional localizing and lateralizing information in this series.

Keywords

Sphenoidal electrode,refractory epilepsy,epilepsy surgery.

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Details

Primary Language

English

Subjects

Health Care Administration

Journal Section

Research Article

Authors

Aşiyan Kilit ^*
0000-0001-6412-0739
Türkiye

Gönül Güvenç
0000-0002-9382-8610
Türkiye

Sabiha Türe
0000-0003-1530-6611
Türkiye

Publication Date

March 13, 2020

Submission Date

October 16, 2018

Acceptance Date

April 3, 2019

Published in Issue

Year 2020 Volume: 59 Number: 1

DOI

https://doi.org/10.19161/etd.699273

IZ

https://izlik.org/JA86CW48ET

Cite

RIS / Bibtex

Vancouver

1.Aşiyan Kilit, Gönül Güvenç, Sabiha Türe. The contribution of sphenoidal electrodes placed under fluoroscopy in lateralization of bilateral refractory temporal lobe epilepsy: a clinical study. EJM. 2020 Mar. 1;59(1):14-21. doi:10.19161/etd.699273