Ứng dụng phương pháp ghi điện não trong mổ trong phẫu thuật động kinh tại Bệnh viện Đại học Y Dược thành phố Hồ Chí Minh

Abstract

Objective: To evaluate the results of epilepsy surgery using electrocortical scoping (ECoG) during surgery, to investigate the role of electrocortical scoping (ECoG) during surgery and some factors related to the results of surgery for drug-resistant epilepsy. Subject and method: A retrospective study describing a series of cases of drug-resistant epilepsy associated with lesions with surgical resection of epileptogenic lesions, using electrocortical scoping (ECoG) during surgery at the University of Medicine and Pharmacy Hospital from January 2022 to June 2024. Result: In 23 patients studied, there were 10 males: 13 females, the average age of surgery was 24.3 years old, patients with uncontrolled epilepsy for 5 years or more accounted for 47.8%. There were 95.7% of cases with a preoperative Karnofsky score of 80-100 points and 4.3% of cases in the 50-70 point group. All cases had interictal epileptiform (IED) signals on preoperative EEG, 73.9% were localized to one lobe, 17.4% were localized to one hemisphere, 8.7% were bilaterally diffuse with a predominance of one side. Preoperative MRI detected lesions in 100% of patients, 52.2% on the left side, 47.8% on the right side, 82.6% had temporal lobe lesions, 8.7% had extratemporal lesions, 8.7% had both intra- and extratemporal lesions. The preoperative surgical plan was modified intraoperatively based on ECoG recordings in 11/23 cases (47.8%). The seizure control rate (Engel I) in patients undergoing epilepsy surgery using intraoperative ECoG was an impressive 87%. Univariate analysis showed that the number of AEDs used preoperatively, the extent of IED spread on preoperative EEG, and the final ECoG score after resection were correlated with postoperative seizure control. Conclusion: Intraoperative electrocorticography is an effective, reliable, and safe tool in epilepsy surgery to guide targeted surgery, localize, and define surgical boundaries to remove epileptogenic brain areas.