The feasibility and value of extraoperative and adjuvant intraoperative stereoelectroencephalography in rolandic and perirolandic epilepsies

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  • 1 Departments of Neurology and
  • 2 Neurosurgery, Epilepsy Center, and
  • 5 Department of Anatomic Pathology, Cleveland Clinic, Cleveland, Ohio;
  • 3 Department of Neurology, Epilepsy Center, Barrow Neurological Institute, Phoenix, Arizona;
  • 4 Department of Neurosurgery, Epilepsy and Movement Disorders Division, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; and
  • 6 Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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OBJECTIVE

The objective of this study was to illustrate the feasibility and value of extra- and intraoperative stereoelectroencephalography (SEEG) in patients who underwent resection in rolandic and perirolandic regions.

METHODS

The authors retrospectively reviewed all consecutive patients with at least 1 year of postoperative follow-up who underwent extra- and intraoperative SEEG monitoring between January 2015 and January 2017.

RESULTS

Four patients with pharmacoresistant rolandic and perirolandic focal epilepsy were identified, who underwent conventional extraoperative invasive SEEG evaluations followed by adjuvant intraoperative SEEG recordings. Conventional extraoperative SEEG evaluations demonstrated ictal and interictal epileptiform activities involving eloquent rolandic and perirolandic cortical areas in all patients. Following extraoperative monitoring, patients underwent preplanned staged resections guided by simultaneous and continuous adjuvant intraoperative SEEG monitoring. Resections, guided by electrode contacts of interest in 3D boundaries, were performed while continuous real-time electrographic data from SEEG recordings were obtained. Staged approaches of resections were performed until there was intraoperative resolution of synchronous rolandic/perirolandic cortex epileptic activities. All patients in the cohort achieved complete seizure freedom (Engel class IA) during the follow-up period ranging from 18 to 50 months. Resection resulted in minimal neurological deficit; 3 patients experienced transient, distal plantar flexion weakness (mild foot drop).

CONCLUSIONS

The seizure and functional outcome results of this highly preselected group of patients testifies to the feasibility and demonstrates the value of the combined benefits of both intra- and extraoperative SEEG recordings when resecting the rolandic and perirolandic areas. The novel hybrid method allows a more refined and precise identification of the epileptogenic zone. Consequently, tailored resections can be performed to minimize morbidity as well as to achieve adequate seizure control.

ABBREVIATIONS AED = antiepileptic drug; DRE = drug-resistant epilepsy; EPC = epilepsia partial continua; EZ = epileptogenic zone; FCD = focal cortical dysplasia; ILAE = International League Against Epilepsy; IOZ = ictal onset zone; PMC = patient management conference; PRE = perirolandic focal epilepsy; RE = rolandic focal epilepsy; SDG = subdural grid; SEEG = stereoelectroencephalography; SMA = supplementary motor area.

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Contributor Notes

Correspondence Thandar Aung: Epilepsy Center, Barrow Neurological Institute, Phoenix, AZ. thandar.aung@dignityhealth.org.

INCLUDE WHEN CITING Published online October 23, 2020; DOI: 10.3171/2020.6.PEDS2099.

Disclosures Dr. Gonzalez-Martinez reports ownership in Neurologic and being a consultant for Zimmer Biomet.

  • 1

    Penfield W, Rasmussen T. The Cerebral Cortex of Man. Macmillan Co; 1950.

  • 2

    Laplane D, Talairach J, Meininger V, Motor consequences of motor area ablations in man. J Neurol Sci. 1977;31(1):2949.

  • 3

    Kotagal P, Arunkumar GS. Lateral frontal lobe seizures. Epilepsia. 1998;39(suppl 4):S62S68.

  • 4

    Catani M, Dell’acqua F, Vergani F, Short frontal lobe connections of the human brain. Cortex. 2012;48(2):273291.

  • 5

    Enatsu R, Bulacio J, Nair DR, Posterior cingulate epilepsy: clinical and neurophysiological analysis. J Neurol Neurosurg Psychiatry. 2014;85(1):4450.

    • Search Google Scholar
    • Export Citation
  • 6

    Vadera S, Mullin J, Bulacio J, Stereoelectroencephalography following subdural grid placement for difficult to localize epilepsy. Neurosurgery. 2013;72(5):723729.

    • Search Google Scholar
    • Export Citation
  • 7

    Gonzalez-Martinez J, Bulacio J, Alexopoulos A, Stereoelectroencephalography in the “difficult to localize” refractory focal epilepsy: early experience from a North American epilepsy center. Epilepsia. 2013;54(2):323330.

    • Search Google Scholar
    • Export Citation
  • 8

    Engel JJ, Van Ness PC, Rasmussen TB, Outcome with respect to epileptic seizures. In: Engel J Jr, ed. Surgical Treatment of the Epilepsies. 2nd ed. Raven Press; 1993:609621.

    • Search Google Scholar
    • Export Citation
  • 9

    Gonzalez-Martinez J, Mullin J, Vadera S, Stereotactic placement of depth electrodes in medically intractable epilepsy. J Neurosurg. 2014;120(3):639644.

    • Search Google Scholar
    • Export Citation
  • 10

    González-Martínez J, Bulacio J, Thompson S, Technique, results, and complications related to robot-assisted stereoelectroencephalography. Neurosurgery. 2016;78(2):169180.

    • Search Google Scholar
    • Export Citation
  • 11

    Dalkilic EB. Neurostimulation devices used in treatment of epilepsy. Curr Treat Options Neurol. 2017;19(2):7.

  • 12

    Child ND, Stead M, Wirrell EC, Chronic subthreshold subdural cortical stimulation for the treatment of focal epilepsy originating from eloquent cortex. Epilepsia. 2014;55(3):e18e21.

    • Search Google Scholar
    • Export Citation
  • 13

    Han SJ, Morshed RA, Troncon I, Subcortical stimulation mapping of descending motor pathways for perirolandic gliomas: assessment of morbidity and functional outcome in 702 cases. J Neurosurg. 2018;131(1):201208.

    • Search Google Scholar
    • Export Citation
  • 14

    De Witt Hamer PC, Robles SG, Zwinderman AH, Impact of intraoperative stimulation brain mapping on glioma surgery outcome: a meta-analysis. J Clin Oncol. 2012;30(20):25592565.

    • Search Google Scholar
    • Export Citation
  • 15

    Benifla M, Sala F Jr, Jane J, Neurosurgical management of intractable rolandic epilepsy in children: role of resection in eloquent cortex. Clinical article. J Neurosurg Pediatr. 2009;4(3):199216.

    • Search Google Scholar
    • Export Citation
  • 16

    Delev D, Send K, Wagner J, Epilepsy surgery of the rolandic and immediate perirolandic cortex: surgical outcome and prognostic factors. Epilepsia. 2014;55(10):15851593.

    • Search Google Scholar
    • Export Citation
  • 17

    Cohen-Gadol AA, Britton JW, Collignon FP, Nonlesional central lobule seizures: use of awake cortical mapping and subdural grid monitoring for resection of seizure focus. J Neurosurg. 2003;98(6):12551262.

    • Search Google Scholar
    • Export Citation
  • 18

    de Oliveira RS, Santos MV, Terra VC, Tailored resections for intractable rolandic cortex epilepsy in children: a single-center experience with 48 consecutive cases. Childs Nerv Syst. 2011;27(5):779785.

    • Search Google Scholar
    • Export Citation
  • 19

    Behdad A, Limbrick DD Jr, Bertrand ME, Smyth MD. Epilepsy surgery in children with seizures arising from the rolandic cortex. Epilepsia. 2009;50(6):14501461.

    • Search Google Scholar
    • Export Citation
  • 20

    Pondal-Sordo M, Diosy D, Téllez-Zenteno JF, Epilepsy surgery involving the sensory-motor cortex. Brain. 2006;129(Pt 12):33073314.

  • 21

    Gonzalez-Martinez JA. The stereo-electroencephalography: the epileptogenic zone. J Clin Neurophysiol. 2016;33(6):522529.

  • 22

    Sarkis RA, Jehi LE, Bingaman WE, Najm IM. Surgical outcome following resection of rolandic focal cortical dysplasia. Epilepsy Res. 2010;90(3):240247.

    • Search Google Scholar
    • Export Citation
  • 23

    Hader WJ, Mackay M, Otsubo H, Cortical dysplastic lesions in children with intractable epilepsy: role of complete resection. J Neurosurg. 2004;100(2)(Suppl Pediatrics):110117.

    • Search Google Scholar
    • Export Citation
  • 24

    Duffau H. Brain mapping in tumors: intraoperative or extraoperative? Epilepsia. 2013;54(9)(suppl 9):7983.

  • 25

    Gil Robles S, Gelisse P, Vergani F, Discrepancies between preoperative stereoencephalography language stimulation mapping and intraoperative awake mapping during resection of focal cortical dysplasia in eloquent areas. Stereotact Funct Neurosurg. 2008;86(6):382390.

    • Search Google Scholar
    • Export Citation
  • 26

    Britton JW. Electrical stimulation mapping with stereo-EEG electrodes. J Clin Neurophysiol. 2018;35(2):110114.

  • 27

    Ritaccio AL, Brunner P, Schalk G. Electrical stimulation mapping of the brain: basic principles and emerging alternatives. J Clin Neurophysiol. 2018;35(2):8697.

    • Search Google Scholar
    • Export Citation
  • 28

    Cheney PD. Electrophysiological methods for mapping brain motor and sensory circuits. In: Toga AW, Mazziotta JC, eds. Brain Mapping: The Methods. 2nd ed. Academic Press; 2002:189226.

    • Search Google Scholar
    • Export Citation
  • 29

    Tavares S, Almeida RM, Figueiroa SM, Temudo T. Rolandic epilepsy. An analysis of the clinical and electrophysiological characteristics, treatment and prognosis in 87 patients. Article in Spanish. Rev Neurol. 2005;41(6):327330.

    • Search Google Scholar
    • Export Citation
  • 30

    Xiao F, Lei D, An D, Functional brain connectome and sensorimotor networks in rolandic epilepsy. Epilepsy Res. 2015;113:113125.

  • 31

    Vergani F, Lacerda L, Martino J, White matter connections of the supplementary motor area in humans. J Neurol Neurosurg Psychiatry. 2014;85(12):13771385.

    • Search Google Scholar
    • Export Citation
  • 32

    Guevara M, Román C, Houenou J, Reproducibility of superficial white matter tracts using diffusion-weighted imaging tractography. Neuroimage. 2017;147:703725.

    • Search Google Scholar
    • Export Citation
  • 33

    Kasasbeh AS, Yarbrough CK, Limbrick DD, Characterization of the supplementary motor area syndrome and seizure outcome after medial frontal lobe resections in pediatric epilepsy surgery. Neurosurgery. 2012;70(5):11521168.

    • Search Google Scholar
    • Export Citation
  • 34

    Berger MS, Kincaid J, Ojemann GA, Lettich E. Brain mapping techniques to maximize resection, safety, and seizure control in children with brain tumors. Neurosurgery. 1989;25(5):786792.

    • Search Google Scholar
    • Export Citation

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