뇌전증수술에서 수술중-수술장외 신경계감시

Abstract

In patients with epilepsy, seizures can be controlled with antiseizure medications (ASMs). However, approximately 30% patients are refractory to treatment with ASMs. Such patients are potential candidates for epilepsy surgery. Scalp electroencephalography (EEG), seizure semiology, structural (magnetic resonance imaging) and functional neuroimaging (positron emission tomography or single-photon emission computed tomography), and neuropsychological testing are used to identify the epileptogenic zone. If the ictal and interictal pattern on scalp EEG is not consistent with that observed using other modalities, such as neuroimaging or seizure semiology, further evaluation using invasive testing should be considered to elucidate the epileptogenic zone and resection margin. During epilepsy surgery with resection, intraoperative neurophysiological monitoring with electrocorticography (ECoG) and functional brain mapping can be used. ECoG and brain mapping techniques are also used extraoperatively to localize seizure focus and functional areas. Recently, transcranial motor evoked potential monitoring has been shown to useful for accurate detection of injury in the pyramidal pathway intraoperatively. Therefore, we aimed to comprehensively summarize the role of intraoperative and extraoperative neurophysiological monitoring and brain mapping in epilepsy surgery.