Neurological Surgery 脳神経外科47巻1号

2019年01月発行

特別寄稿 脳神経外科コントロバーシー2019

（1）てんかん外科における頭蓋内脳波の適応

著者： 岩崎真樹¹ 高山裕太郎¹ 飯島圭哉¹ 木村唯子¹ 村岡範裕¹ 金子裕¹

所属機関： ¹国立精神・神経医療研究センター病院脳神経外科

ページ範囲：P.5 - P.14

Ⅰ．はじめに
　モントリオール神経研究所で，Penfieldらによっててんかん外科の術前精査としての頭蓋内電極留置術が初めて行われたのは，1939年に遡る²⁾．当初は硬膜「外」に電極が留置されたが，その後は硬膜下電極が主流となった．一方，定位的深部電極留置によるてんかんの術前評価は，Talairachらによって1950年代に導入された³⁰⁾．それから現在まで，両者の技術を用いた頭蓋内脳波測定は，てんかん外科の術前精査におけるgold standardであり続けている¹⁸⁾．
　てんかん外科の領域において，頭蓋内電極留置は汎用される手技であり，新しいデバイスの登場で低侵襲化も進んでいる．一方，画像診断の進歩や経験の蓄積により，切除計画に電極留置を要さないケースも増えている．頭蓋内電極留置の適応には施設間の差が大きいが，おおむね切除術を行う症例の20〜40%に施行されている¹⁸⁾．頭蓋内電極留置は，全身麻酔と開頭・穿頭を要する侵襲を伴う手技なので，適応は常に慎重であるべきである．本稿では，頭蓋内脳波測定の基本的な方法や理念から，その適応と限界について紹介する．

参考文献

1) Abou-Al-Shaar H, Brock AA, Kundu B, Englot DJ, Rolston JD：Increased nationwide use of stereoencephalography for intracranial epilepsy electroencephalography recordings. J Clin Neurosci 53：132-134, 2018

2) Almeida AN, Martinez V, Feindel W：The first case of invasive EEG monitoring for the surgical treatment of epilepsy：historical significance and context. Epilepsia 46：1082-1085, 2005

3) Arya R, Mangano FT, Horn PS, Holland KD, Rose DF, Glauser TA：Adverse events related to extraoperative invasive EEG monitoring with subdural grid electrodes：a systematic review and meta-analysis. Epilepsia 54：828-839, 2013

4) Baumann CR, Schuknecht B, Lo Russo G, Cossu M, Citterio A, Andermann F, Siegel AM：Seizure outcome after resection of cavernous malformations is better when surrounding hemosiderin-stained brain also is removed. Epilepsia 47：563-566, 2006

5) Cardinale F, Cossu M, Castana L, Casaceli G, Schiariti MP, Miserocchi A, Fuschillo D, Moscato A, Caborni C, Arnulfo G, Lo Russo G：Stereoelectroencephalography：surgical methodology, safety, and stereotactic application accuracy in 500 procedures. Neurosurgery 72：353-366；discussion 366, 2013

6) Chassoux F, Rodrigo S, Semah F, Beuvon F, Landre E, Devaux B, Turak B, Mellerio C, Meder JF, Roux FX, Daumas-Duport C, Merlet P, Dulac O, Chiron C：FDG-PET improves surgical outcome in negative MRI Taylor-type focal cortical dysplasias. Neurology 75：2168-2175, 2010

7) Chassoux F, Landré E, Mellerio C, Turak B, Mann MW, Daumas-Duport C, Chiron C, Devaux B：Type II focal cortical dysplasia：electroclinical phenotype and surgical outcome related to imaging. Epilepsia 53：349-358, 2012

8) Cossu M, Cardinale F, Castana L, Citterio A, Francione S, Tassi L, Benabid AL, Lo Russo G：Stereoelectroencephalography in the presurgical evaluation of focal epilepsy：a retrospective analysis of 215 procedures. Neurosurgery 57：706-718；discussion 706-718, 2005

9) Eldin SS, Iwasaki M, Nishio Y, Jin K, Nakasato N, Tominaga T：Resection of focal cortical dysplasia located in the upper pre-central gyrus. Epileptic Disord 17：479-484, 2015

10) Giulioni M, Marucci G, Pelliccia V, Gozzo F, Barba C, Didato G, Villani F, Di Gennaro G, Quarato PP, Esposito V, Consales A, Martinoni M, Vornetti G, Zenesini C, Efisio Marras C, Specchio N, De Palma L, Rocchi R, Giordano F, Tringali G, Nozza P, Colicchio G, Rubboli G, Lo Russo G, Guerrini R, Tinuper P, Cardinale F, Cossu M；Commission for Epilepsy Surgery of the Italian League Against Epilepsy：Epilepsy surgery of “low grade epilepsy associated neuroepithelial tumors”：a retrospective nationwide Italian study. Epilepsia 58：1832-1841, 2017

11) Gonzalez-Martinez J, Bulacio J, Alexopoulos A, Jehi L, Bingaman W, Najm I：Stereoelectroencephalography in the “difficult to localize” refractory focal epilepsy：early experience from a North American epilepsy center. Epilepsia 54：323-330, 2013

12) Iwasaki M, Jin K, Nakasato N, Tominaga T：Non-invasive evaluation for epilepsy surgery. Neurol Med Chir（Tokyo）56：632-640, 2016

13) Jacobs J, Staba R, Asano E, Otsubo H, Wu JY, Zijlmans M, Mohamed I, Kahane P, Dubeau F, Navarro V, Gotman J：High-frequency oscillations（HFOs）in clinical epilepsy. Prog Neurobiol 98：302-315, 2012

14) Jacobs J, Wu JY, Perucca P, Zelmann R, Mader M, Dubeau F, Mathern GW, Schulze-Bonhage A, Gotman J：Removing high-frequency oscillations：a prospective multicenter study on seizure outcome. Neurology 91：e1040-e1052, 2018

15) Jiménez-Jiménez D, Nekkare R, Flores L, Chatzidimou K, Bodi I, Honavar M, Mullatti N, Elwes RD, Selway RP, Valentín A, Alarcón G：Prognostic value of intracranial seizure onset patterns for surgical outcome of the treatment of epilepsy. Clin Neurophysiol 126：257-267, 2015

16) Josephson CB, Dykeman J, Fiest KM, Liu X, Sadler RM, Jette N, Wiebe S：Systematic review and meta-analysis of standard vs selective temporal lobe epilepsy surgery. Neurology 80：1669-1676, 2013

17) Kanazawa K, Matsumoto R, Imamura H, Matsuhashi M, Kikuchi T, Kunieda T, Mikuni N, Miyamoto S, Takahashi R, Ikeda A：Intracranially recorded ictal direct current shifts may precede high frequency oscillations in human epilepsy. Clin Neurophysiol 126：47-59, 2015

18) Kovac S, Vakharia VN, Scott C, Diehl B：Invasive epilepsy surgery evaluation. Seizure 44：125-136, 2017

19) Mintzer S, Cendes F, Soss J, Andermann F, Engel J Jr, Dubeau F, Olivier A, Fried I：Unilateral hippocampal sclerosis with contralateral temporal scalp ictal onset. Epilepsia 45：792-802, 2004

20) Motoi H, Miyakoshi M, Abel TJ, Jeong JW, Nakai Y, Sugiura A, Luat AF, Agarwal R, Sood S, Asano E：Phase-amplitude coupling between interictal high-frequency activity and slow waves in epilepsy surgery. Epilepsia 59：1954-1965, 2018

21) Nariai H, Matsuzaki N, Juhász C, Nagasawa T, Sood S, Chugani HT, Asano E：Ictal high-frequency oscillations at 80-200 Hz coupled with delta phase in epileptic spasms. Epilepsia 52：e130-e134, 2011

22) Palmini A, Paglioli E, Silva VD：Developmental tumors and adjacent cortical dysplasia：single or dual pathology? Epilepsia 54（Suppl 9）：18-24, 2013

23) Pelliccia V, Deleo F, Gozzo F, Sartori I, Mai R, Cossu M, Tassi L：Early and late epilepsy surgery in focal epilepsies associated with long-term epilepsy-associated tumors. J Neurosurg 127：1147-1152, 2017

24) Perucca P, Dubeau F, Gotman J：Intracranial electroencephalographic seizure-onset patterns：effect of underlying pathology. Brain 137（Pt 1）：183-196, 2014

25) Ramantani G, Dümpelmann M, Koessler L, Brandt A, Cosandier-Rimélé D, Zentner J, Schulze-Bonhage A, Maillard LG：Simultaneous subdural and scalp EEG correlates of frontal lobe epileptic sources. Epilepsia 55：278-288, 2014

26) Rosenow F, Lüders H：Presurgical evaluation of epilepsy. Brain 124（Pt 9）：1683-1700, 2001

27) Rosenow F, Alonso-Vanegas MA, Baumgartner C, Blümcke I, Carreño M, Gizewski ER, Hamer HM, Knake S, Kahane P, Lüders HO, Mathern GW, Menzler K, Miller J, Otsuki T, Ozkara C, Pitkänen A, Roper SN, Sakamoto AC, Sure U, Walker MC, Steinhoff BJ；Surgical Task Force, Commission on Therapeutic Strategies of the ILAE：Cavernoma-related epilepsy：review and recommendations for management--report of the Surgical Task Force of the ILAE Commission on Therapeutic Strategies. Epilepsia 54：2025-2035, 2013

28) Salamon N, Kung J, Shaw SJ, Koo J, Koh S, Wu JY, Lerner JT, Sankar R, Shields WD, Engel J Jr, Fried I, Miyata H, Yong WH, Vinters HV, Mathern GW：FDG-PET/MRI coregistration improves detection of cortical dysplasia in patients with epilepsy. Neurology 71：1594-1601, 2008

29) Takada S, Iwasaki M, Suzuki H, Nakasato N, Kumabe T, Tominaga T：Angiocentric glioma and surrounding cortical dysplasia manifesting as intractable frontal lobe epilepsy--case report. Neurol Med Chir（Tokyo）51：522-526, 2011

30) Talairach J, Bancaud J, Bonis A, Szikla G, Tournoux P：Functional stereotaxic exploration of epilepsy. Confin Neurol 22：328-331, 1962

31) Tripathi M, Garg A, Gaikwad S, Bal CS, Chitra S, Prasad K, Dash HH, Sharma BS, Chandra PS：Intra-operative electrocorticography in lesional epilepsy. Epilepsy Res 89：133-141, 2010

32) Wagner J, Urbach H, Niehusmann P, von Lehe M, Elger CE, Wellmer J：Focal cortical dysplasia type IIb：completeness of cortical, not subcortical, resection is necessary for seizure freedom. Epilepsia 52：1418-1424, 2011

33) Wellmer J, von der Groeben F, Klarmann U, Weber C, Elger CE, Urbach H, Clusmann H, von Lehe M：Risks and benefits of invasive epilepsy surgery workup with implanted subdural and depth electrodes. Epilepsia 53：1322-1332, 2012