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A new electrode design for the extradural recording of electrical brain activity is described. Epidural peg electrodes are implantable mushroom-shaped composites of Silastic clastomer and a stainless steel or platinum disc. These electrodes are useful for the preoperative mapping of seizure foci in some patients who have cranial defects or severe muscle artifacts on scalp recordings. They are also used for canvassing wide areas of cortex to determine whether a seizure is focal in origin, arises diffusely from a hemisphere, or has a bilateral origin. Advantages of epidural peg electrodes over screw and other types of epidural electrodes include low risk of infection or hemorrhage and improved patient comfort.

Summary: In evaluation of patients with complex partial seizures who are candidates for surgical treatment, exact definition of the epileptogenic focus is essential for a good surgical outcome. We report a new technique which permits detailed mapping of the epileptogenic activity in the basal temporal lobe and the convexity of the temporal lobe. The technique consists of placement of at least 16 basal temporal electrodes and an additional 64 electrodes covering the temporal convexity. This extensive coverage permits accurate definition of the limits of the epileptogenic focus and also of adjacent functional areas and therefore allows more significant determination than have previous techniques of the ideal extent of the surgical resection. This accuracy cannot be achieved with depth electrodes or the limited coverage provided by previously reported epidural or subdural electrode techniques. RESUME Dans le bilan de patients presentant des crises partielles complexes et qui sont candidats a un traitement chirurgical, une definition exact du foyer epileptogene est essentielle dans la perspective d'un bon resultat post-operatoire. Les auteurs rappor-tent une nouvelle technique qui permet d'etablir une topographie detaillee de l'activite paroxystique dans la region basale et la convexite du lobe temporal. Cette technique consiste a placer un minimum de 16 electrodes temporales basales et 64 electrodes supplementaires sur la convexite temporale. Cette large couverture permet de defiinir precisement les limites du foyer ṕileptogene et des regions fonctionnelles adjacentes; elle permet done de determiner avec une precision superieure a celle des techniques anterieures l'extension ideale de la resection chirurgicale. Cette precision ne peut etre obtenue par des electrodes pro-fondes ou par la couverture limitee fournie par les techniques anterieurement decrites utilisant des electrodes epi- ou sous-durales. RESUMEN En la evaluacion de enfermos con ataques parciales comple-jos, considerados como candidates para tratamiento quirurgico, resulta esencial la definiciom del foco epileptogenico para consequir unos resultados quirurgicos de buena calidad. Se presenta una tecnica nueva que permite conseguir un mapa detallado de la actividad epileptogenica en la region basal y en la convexidad del lobulo temporal. Esta tecnica consiste en la colocacion de, al menos, 16 electrodos basales temporales y de 64 electrodos que cubren la convexidad del lobulo temporal. Esta amplia cobertura permite una valida definicion de los limites de los focos epilep-togenicos y tambien de las areas funcionales adyacentes que, por lo tan to, permite determinar con precision, mas fiable que con tecnicas previas, la amplitud ideal de la reseccion quirurgica. Esta exactitud no puede consequirse con electrodos profundos ni con el emplazamiento de electrodos epi o subdurales como ha sido previamente publicado. ZUSAMMENFASSUNG Bei der Untersuchung der Patienten mit komplexen Partialan-fallen, die moglicherweise fur eine chirurgische Behandlung in Frage kommen, ist eine genaue Abgrenzung des epileptogenen Fokus' unabdingbar fur einen guten Operationserfolg. Wir be-richten uber eine neue Technik, welche ein detailliertes Mapping der epileptogenen Aktivitat uber der Basis und der Konvexitat des Temporallappens erlaubt. Die Technik umfaβt die Plazierung von wenigstens 16 basalen Elektroden und Weiteren 64 Konvex-itatselektroden. Diese dichte Besetzung erlaubt die akkurate Abgrenzung der Fokusregion sowie angrenzender funktioneller Ge-biete. Damit laβt sich mit signifikant besserer Zuverlassigkeit das Ausmaβ der vorgesehenen Resektion fest bestimmen. Die Genauigkeit kann weder mit Tiefenelektroden noch mit be-grenzten Ableitungen–wie kurzhch berichtet–durch epi- oder subdurale Elektroden-Technik erreicht werden.

A technique for injection of sclerosing agents into esophageal varices using a fiberoptic endoscope in conscious but sedated patients was evaluated. With a flexible needle of our own design, 82 such procedures were performed in 22 patients over a period of 17 months. A solution of 0.5% sodium tetradecyl Sulfate, 50% glucose, and 3.5 units of bovine thrombin per ml was used. None of the patients were surgical candidates and all presented with variceal hemorrhage. The complication rate was 2.4% (two of 82 procedures). Prior to beginning injection sclerosis the 22 patients had sustained an average of 3.8 episodes of hemorrhage and the average transfusion requirement was 25.7 units per patient. After instituting therapy the number of episodes of hemorrhage averaged 1.3 per patient with a mean transfusion requirement of 7.3 units.