Do sphenoidal electrodes aid in surgical decision making in drug resistant XXXX ?

@entity1 @entity3877 @entity162 @entity410 @entity1315 @entity302 @entity25474
OBJECTIVE: The utility of sphenoidal electrodes (SPh) in analyzing @entity302 ( @entity302 ) and ictal electrography remains controversial, despite its widespread use. METHODS: One hundred and twenty-two consecutive @entity1 with presumed @entity1315 ( @entity1315 ) who underwent presurgical evaluation were prospectively studied. SPh and Silverman's electrodes were placed, in addition to routine electrodes in 10-20 international system. @entity302 and ictal electroencephalography (EEG) were analyzed separately in bipolar and referential montages. The proportion of @entity1 selected for surgery after adjusting for SPh placement based on the earlier ictal onset and @entity302 were analyzed. RESULTS: Of the 8701 @entity302 in SPh, only 65% were seen over the scalp @entity162 ; 1392 (16%) @entity302 were confined to SPh electrodes, and were not seen at scalp @entity162 (p<0.001). Spike amplitudes were highest at SPh (p<0.001). Of the 592 @entity410 analyzed, 62 (61%) had simultaneous SPh and scalp onset, while in 26 (25%) SPh onset preceded the scalp. CONCLUSIONS: Out of the 35 @entity1 with @entity3877 ( @entity3877 ) with additional neocortical changes and/or non-lateralized bitemporal @entity302 and/or diffuse ictal onset (group 1), 27 were selected for surgery (77%). About 7% was selected for surgery in this group by SPh placement. Also, in @entity1 with bilateral @entity3877 (group 2), 25% (5/20) were chosen for anterior temporal lobectomy, SPh provided an additional benefit in 11% (p<0.001). @entity1 with normal magnetic resonance imaging (group 3) and @entity25474 (group 4) had a lower surgical yield, only 12% and 9.5% could undergo surgery. They were denied surgical candidacy with SPh (p<0.001). SIGNIFICANCE: One-third of @entity1 after SPh placement were selected for resective surgery obviating the need for invasive monitoring. The maximum yield was noted in unilateral @entity3877 (associated with additional neocortical features or non-lateralized bilateral temporal interictal @entity302 or diffuse ictal onset in scalp EEG) and in bilateral @entity3877 . Those with normal MRI/ @entity25474 could be excluded from direct resective surgery.
