Epilepsy is common among patients with supratentorial brain tumors; approximately 40%–70% of patients with glioma develop brain tumor–related epilepsy (BTRE). Intraoperative localization of the epileptogenic zone during surgical tumor resection (real-time data) may improve intervention techniques in patients with lesional epilepsy, including BTRE. Accurate localization of the epileptogenic signals requires electrodes with high-density spatial organization that must be placed on the cortical surface during surgery. The authors investigated a 360° high-density ring-shaped cortical electrode assembly device, called the “circular grid,” that allows for simultaneous tumor resection and real-time electrophysiology data recording from the brain surface.
The authors collected data from 99 patients who underwent awake craniotomy from January 2008 to December 2018 (29 patients with the circular grid and 70 patients with strip electrodes), of whom 50 patients were matched-pair analyzed (25 patients with the circular grid and 25 patients with strip electrodes). Multiple variables were then retrospectively assessed to determine if utilization of this device provides more accurate real-time data and improves patient outcomes.
Matched-pair analysis showed higher extent of resection (p = 0.03) and a shorter transient motor recovery period during the hospitalization course (by approximately 6.6 days, p ≤ 0.05) in the circular grid patients. Postoperative versus preoperative Karnofsky Performance Scale (KPS) score difference/drop was greater for the strip electrode patients (p = 0.007). No significant difference in postoperative seizures between the 2 groups was present (p = 0.80).
The circular grid is a safe, feasible tool that grants direct access to the cortical surgical surface for tissue resection while simultaneously monitoring electrical activity. Application of the circular grid to different brain pathologies may improve intraoperative epileptogenic detection accuracy and functional outcomes, while decreasing postoperative complications.
ABBREVIATIONSAD = afterdischarge; ECoG = electrocorticography; EOR = extent of resection; HD = high-density; KPS = Karnofsky Performance Scale; LOS = length of hospital stay.
AlmeidaAN, MartinezV, FeindelW: The first case of invasive EEG monitoring for the surgical treatment of epilepsy: historical significance and context. 46:1082–1085, 200510.1111/j.1528-1167.2005.66404.x16026560)| false
ArechigaNReFaeyKRincon-TorroellaJChaichanaKQuiñones-HinojosaA: Cortical/subcortical motor mapping for gliomas in Quiñones-HinojosaA (ed): Video Atlas of Neurosurgery: Contemporary Tumor and Skull Base Surgery. Philadelphia: Elsevier2016Vol 1
ArechigaN, ReFaeyK, Rincon-TorroellaJ, ChaichanaK, Quiñones-HinojosaA: Cortical/subcortical motor mapping for gliomas, in Quiñones-HinojosaA (ed): . Philadelphia: Elsevier, 2016, Vol 1)| false
BergerMS, KincaidJ, OjemannGA, LettichE: Brain mapping techniques to maximize resection, safety, and seizure control in children with brain tumors. 25:786–792, 198910.1227/00006123-198911000-000152586730)| false
BrunnerPRitaccioALLynchTMEmrichJFWilsonJAWilliamsJC: A practical procedure for real-time functional mapping of eloquent cortex using electrocorticographic signals in humans. Epilepsy Behav15:278–2862009
BrunnerP, RitaccioAL, LynchTM, EmrichJF, WilsonJA, WilliamsJC, : A practical procedure for real-time functional mapping of eloquent cortex using electrocorticographic signals in humans. 15:278–286, 20091936663810.1016/j.yebeh.2009.04.001)| false
ChaichanaKL, Cabrera-AldanaEE, Jusue-TorresI, WijesekeraO, OliviA, RahmanM, : When gross total resection of a glioblastoma is possible, how much resection should be achieved?82:e257–e265, 201410.1016/j.wneu.2014.01.019)| false
ChaichanaKLJusue-TorresILemosAMGokaslanACabrera-AldanaEEAsharyA: The butterfly effect on glioblastoma: is volumetric extent of resection more effective than biopsy for these tumors?J Neurooncol120:625–6342014
ChaichanaKL, Jusue-TorresI, LemosAM, GokaslanA, Cabrera-AldanaEE, AsharyA, : The butterfly effect on glioblastoma: is volumetric extent of resection more effective than biopsy for these tumors?120:625–634, 20142519302210.1007/s11060-014-1597-9)| false
ChoJRKooDLJooEYSeoDWHongSCJiruskaP: Resection of individually identified high-rate high-frequency oscillations region is associated with favorable outcome in neocortical epilepsy. Epilepsia55:1872–18832014
EseonuCIEguiaFReFaeyKGarciaORodriguezFJChaichanaK: Comparative volumetric analysis of the extent of resection of molecularly and histologically distinct low grade gliomas and its role on survival. J Neurooncol134:65–742017
EseonuCI, EguiaF, ReFaeyK, GarciaO, RodriguezFJ, ChaichanaK, : Comparative volumetric analysis of the extent of resection of molecularly and histologically distinct low grade gliomas and its role on survival. 134:65–74, 201710.1007/s11060-017-2486-928527004)| false
EseonuCIRincon-TorroellaJReFaeyKLeeYMNangianaJVivas-BuitragoT: Awake craniotomy vs craniotomy under general anesthesia for perirolandic gliomas: evaluating perioperative complications and extent of resection. Neurosurgery81:481–4892017
EseonuCI, Rincon-TorroellaJ, ReFaeyK, LeeYM, NangianaJ, Vivas-BuitragoT, : Awake craniotomy vs craniotomy under general anesthesia for perirolandic gliomas: evaluating perioperative complications and extent of resection. 81:481–489, 201710.1093/neuros/nyx02328327900)| false
KwanPArzimanoglouABergATBrodieMJAllen HauserWMathernG: Definition of drug resistant epilepsy: consensus proposal by the ad hoc Task Force of the ILAE Commission on Therapeutic Strategies. Epilepsia51:1069–10772010
KwanP, ArzimanoglouA, BergAT, BrodieMJ, Allen HauserW, MathernG, : Definition of drug resistant epilepsy: consensus proposal by the ad hoc Task Force of the ILAE Commission on Therapeutic Strategies. 51:1069–1077, 201010.1111/j.1528-1167.2009.02397.x19889013)| false
Quiñones-HinojosaAOjemannSGSanaiNDillonWPBergerMS: Preoperative correlation of intraoperative cortical mapping with magnetic resonance imaging landmarks to predict localization of the Broca area. J Neurosurg99:311–3182003
Quiñones-HinojosaA, OjemannSG, SanaiN, DillonWP, BergerMS: Preoperative correlation of intraoperative cortical mapping with magnetic resonance imaging landmarks to predict localization of the Broca area. 99:311–318, 20031292470610.3171/jns.2003.99.2.0311)| false
van ’t KloosterMA, van KlinkNE, LeijtenFS, ZelmannR, GebbinkTA, GosselaarPH, : Residual fast ripples in the intraoperative corticogram predict epilepsy surgery outcome. 85:120–128, 201510.1212/WNL.0000000000001727)| false
VogelRW: Understanding anodal and cathodal stimulation. The ASNM Monitor. December 12017(https://www.asnm.org/blogpost/1635804/290597/Understanding-Anodal-and-Cathodal-Stimulation) [Accessed May 8 2019]
VogelRW: Understanding anodal and cathodal stimulation. The ASNM Monitor. December 1, 2017(https://www.asnm.org/blogpost/1635804/290597/Understanding-Anodal-and-Cathodal-Stimulation) [Accessed May 8, 2019])| false