Zastosowanie monitorowania wideo-elektroencefalograficznego w połączeniu z wielomodalnymi badaniami obrazowymi w chirurgicznym leczeniu wtórnej epilepsji u dzieci

Abstract Objective To explore the clinical value of video‑electroencephalography (VEEG) coupled with multimodal imaging for pre‑surgical epileptogenic‑zone localization, surgical planning and prognostic evaluation in children with drug‑resistant epilepsy. Methods : A retrospective analysis was performed on 42 pediatric patients who underwent epilepsy surgery. Pre‑operative workup included brain magnetic resonance imaging (MRI), long‑term scalp VEEG, and PET‑CT for selected participants. For diagnostically challenging cases, stereoelectroencephalography (SEEG) depth electrodes or electrocorticography (ECoG) cortical electrodes were implanted to refine epileptogenic‑zone identification. Cortical electrical stimulation (CES) and somatosensory evoked potentials (SEP) were applied to map eloquent brain regions. Intra‑operative cortical electrophysiological monitoring guided lesion resection. Individualized surgical strategies were adopted according to lesion characteristics. Post‑operative follow‑up spanned 1‑4 years, and seizure outcomes were assessed using the modified Engel classification. Results : ① Pre‑operative brain MRI revealed heterogeneous epileptogenic etiologies, most frequently temporal‑lobe signal abnormalities (17 cases) and focal cortical developmental anomalies (12 cases). ② Long‑term VEEG allowed detailed recording of background electroencephalographic rhythms; sleep markedly elevated the yield of interictal epileptiform discharges. Interictal discharges were captured in 35 patients, and spontaneous clinical seizure discharges were successfully recorded in 15 patients. ③ Among 21 patients receiving PET‑CT, focal hypometabolism was observed within most lesion territories. ④ Combined long‑term VEEG with intracranial SEEG/ECoG electrodes precisely delineated discharge onset zones, while functional‑mapping techniques ensured operative safety. ⑤ Ten distinct individualized surgical protocols were implemented tailored to underlying pathology. Intra‑operative ECoG detected sharp‑wave activity in 35 patients, informing the extent of surgical resection. ⑥ Integrating MRI findings with post‑surgical histopathology clarified the etiological diagnosis for all patients. ⑦ After 1‑4 years of follow‑up, 33 patients attained Engel class I outcomes, indicating satisfactory overall seizure control. Note: Developmental anomalies encompass structural malformations and signal alterations, collectively termed cortical developmental abnormalities herein. Conclusions :Video‑electroencephalography combined with multimodal imaging including MRI and PET‑CT enables reasonably accurate (though not absolute) dual anatomical‑electrophysiological localization of epileptogenic zones. This multimodal framework provides robust evidence for individualized surgical planning and bears considerable clinical utility.