Pseudoaneurysm Formation after Stereoencephalography for Epilepsy.

IF 1.9 4区 医学 Q3 NEUROIMAGING
Henry M Skelton, Nealen G Laxpati, Jason J Lamanna, Faical Isbaine, Daniel L Barrow, Robert E Gross
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Abstract

Introduction: Stereoencephalography (SEEG) has emerged as the most common technique for invasive monitoring as part of the preoperative workup for epilepsy surgery. The use of intracranial implants has the potential for vascular injury giving rise to pseudoaneurysm, followed by unpredictable, delayed hemorrhage. Confirmed cases of post-SEEG pseudoaneurysm, as well as suspected cases involving delayed hemorrhage after explanation, are very rare and have not allowed identification of the inciting cause.

Case presentation: A patient was evaluated over the course of two SEEG implantations before the decision to proceed with deep brain stimulation (DBS) of the anterior nucleus of the thalamus (ANT) to treat their drug-resistant epilepsy. Preoperative imaging for DBS revealed a pseudoaneurysm proximal to an SEEG craniostomy site. The lesion was treated with excision and vascular bypass, and the patient ultimately underwent DBS as planned. Retrospective analysis strongly implicated the SEEG implantation in pseudoaneurysmal formation, most likely via arterial collision resulting from entry site deviation from the planned stereotactic trajectory.

Conclusion: Pseudoaneurysm may be a more prevalent complication of SEEG than existing literature would suggest, as the delayed formation of these lesions can allow them to escape recognition on routine postoperative imaging. Though likely still uncommon, this may suggest the prudence of additional radiological surveillance. This complication is potentially devastating if unrecognized and untreated, but otherwise does not preclude further surgical therapies for epilepsy.

癫痫立体脑电图后假性动脉瘤的形成。
作为癫痫手术术前检查的一部分,立体脑电图(SEEG)已成为侵入性监测最常用的技术。颅内植入物的使用有可能造成血管损伤,导致假性动脉瘤,随后出现不可预测的迟发性出血。然而,虽然在SEEG植入后严重的迟发性出血病例中怀疑存在这种情况,但没有证实的假性动脉瘤继发于SEEG植入。在决定继续进行丘脑前核深部脑刺激(DBS)治疗其耐药癫痫之前,对患者进行了两次SEEG植入过程的评估。DBS术前成像显示假动脉瘤近端SEEG开颅术部位。病变通过切除和血管搭桥治疗,患者最终按计划接受了DBS。回顾性分析强烈暗示SEEG植入假性动脉瘤形成,最有可能是由于进入部位偏离计划的立体定向轨迹导致的动脉碰撞。结论假性动脉瘤可能是SEEG的常见并发症,比现有文献所认为的更为普遍,因为这些病变的延迟形成可能使其逃避常规术后影像学的识别。尽管可能仍然不常见,但这可能表明需要谨慎地进行额外的放射监测。如果不加以认识和治疗,这种并发症可能是毁灭性的,但除此之外,并不排除进一步的手术治疗癫痫。
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来源期刊
CiteScore
3.80
自引率
0.00%
发文量
33
审稿时长
3 months
期刊介绍: ''Stereotactic and Functional Neurosurgery'' provides a single source for the reader to keep abreast of developments in the most rapidly advancing subspecialty within neurosurgery. Technological advances in computer-assisted surgery, robotics, imaging and neurophysiology are being applied to clinical problems with ever-increasing rapidity in stereotaxis more than any other field, providing opportunities for new approaches to surgical and radiotherapeutic management of diseases of the brain, spinal cord, and spine. Issues feature advances in the use of deep-brain stimulation, imaging-guided techniques in stereotactic biopsy and craniotomy, stereotactic radiosurgery, and stereotactically implanted and guided radiotherapeutics and biologicals in the treatment of functional and movement disorders, brain tumors, and other diseases of the brain. Background information from basic science laboratories related to such clinical advances provides the reader with an overall perspective of this field. Proceedings and abstracts from many of the key international meetings furnish an overview of this specialty available nowhere else. ''Stereotactic and Functional Neurosurgery'' meets the information needs of both investigators and clinicians in this rapidly advancing field.
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