Abstract
Objective To explore the value of stereo-electroencephalogram (SEEG) based on multimodal images in the evaluation and treatment of pediatric refractory epilepsy. Methods A retrospective analysis was conducted on 11 cases who underwent stereotactic intracranial electrode implantation at Department of Neurosurgery, Children′s Hospital of Fudan University from July 2016 to August 2017. The epileptogenic zone was evaluated by analyzing the seizure semiology, electrophysiological studies and neuroimaging. Image processing software SINOPLAN was used for multimodal image fusion, three-dimensional visualization of the cerebral cortex and SEEG electrode implantation. According to the EEG recorded through the stereotactically implanted electrodes, the epileptogenic focus was identified and the resection range was determined to guide the second-stage operation. Engel classification was used to evaluate the outcomes post operation. Meanwhile, the language and neuropsychological development of the children were evaluated. Results In 11 patients, 103 electrodes were implanted with an average of 9±2 per patient. The epileptogenic foci were identified and surgical resections were performed in all patients. No bleeding, infection, cerebral infarction or hydrocephalus occurred post operation. The postoperative pathological results showed focal cortical dysplasia (FCD) Ⅱa in 2 cases, FCD Ⅱb in 5, FCD Ⅲa in 1, FCD Ⅲb in 1, FCD Ⅲc in 1 and hippocampal sclerosis in 1. The follow-up time was 6-16 months, with an average of 10.4±2.9 months. Engle Ⅰ was reported in 10 cases and Engle Ⅲ in 1. None of the patients had language dysfunction. One patient with epileptic zone involving paracentral lobule had contralateral lower limb dysfunction and recovered following rehabilitation. The neuropsychological development was improved in 2 patients after surgery(pre-operation: 51 and 55 vs. post-operation: 75 and 81) assessed by Merriam-Webster's intelligence scale. Conclusion Multimodal images are beneficial to the identification of epileptogenic foci and could guide implantation of SEEG electrodes which seems safe and efficient under three-dimensional visual condition and thus suitable for children with intractable epilepsy. Key words: Epilepsy; Child; Stereo-electroencephalogram; Multimodal image
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