医学
开颅术
神经刺激
外科
癫痫外科
立体定向
手术计划
铅(地质)
癫痫
精神科
内科学
地质学
地貌学
触觉技术
操作系统
计算机科学
刺激
作者
Max Krucoff,Thomas A. Wozny,Anthony T Lee,Vikram R. Rao,Edward F. Chang
出处
期刊:Operative Neurosurgery
[Oxford University Press]
日期:2020-10-19
卷期号:20 (2): E98-E109
被引量:15
摘要
Abstract BACKGROUND The Responsive Neurostimulation (RNS)® System (NeuroPace, Inc) is an implantable device designed to improve seizure control in patients with medically refractory focal epilepsy. Because it is relatively new, surgical pearls and operative techniques optimized from experience beyond a small case series have yet to be described. OBJECTIVE To provide a detailed description of our operative technique and surgical pearls learned from implantation of the RNS System in 57 patients at our institution. We describe our method for frame-based placement of amygdalo-hippocampal depth leads, open implantation of cortical strip leads, and open installation of the neurostimulator. METHODS We outline considerations for patient selection, preoperative planning, surgical positioning, incision planning, stereotactic depth lead implantation, cortical strip lead implantation, craniotomy for neurostimulator implantation, device testing, closure, and intraoperative imaging. RESULTS The median reduction in clinical seizure frequency was 60% (standard deviation 63.1) with 27% of patients achieving seizure freedom at last follow up (median 23.1 mo). No infections, intracerebral hemorrhages, or lead migrations were encountered. Two patients experienced lead fractures, and four lead exchanges have been performed. CONCLUSION The techniques set forth here will help with the safe and efficient implantation of these new devices.
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