Is postresective intraoperative electrocorticography predictive of seizure outcomes in children?

Clinical article

Restricted access

Object

Intraoperative electrocorticography (ECoG) is commonly used to guide the extent of resection, especially in lesion-associated intractable epilepsy. Interictal epileptiform discharges on postresective ECoG (post-ECoG) have been predictive of seizure recurrence in some studies, particularly in adults undergoing medial temporal lobectomy, frontal lesionectomy, or low-grade glioma resection. The predictive value of postresective discharges in pediatric epilepsy surgery has not been extensively studied.

Methods

The authors retrospectively examined the charts of all 52 pediatric patients who had undergone surgery with post-ECoG and had more than 1 year of follow-up between October 1, 2003, and October 1, 2009.

Results

Of the 52 pediatric patients, 37 patients showed residual discharges at the end of their resection and 73% of these patients were seizure free, whereas 15 patients had no residual discharges and 60% of them were seizure-free, which was not significantly different (p = 0.36, chi-square).

Conclusions

Electrocorticography-guided surgery was associated with excellent postsurgical outcome. Although this sample size was too small to detect a subtle difference, absence of epileptiform discharges on post-ECoG does not appear to predict seizure freedom in all pediatric patients referred for epilepsy surgery. Future studies with larger study samples would be necessary to confirm this finding and determine whether post-ECoG may be useful in some subsets of pediatric epilepsy surgery candidates.

Abbreviations used in this paper:ECoG = electrocorticography; EEG = electroencephalography; pre-ECoG = preresective ECoG; post-EEG = postresective ECoG.

Article Information

Address correspondence to: Carter D. Wray, M.D., Division of Pediatric Neurology, 707 SW Gaines Street, Mail Code CDRC-P, Portland, Oregon 97239. email: carterwraymd@gmail.com.

Please include this information when citing this paper: DOI: 10.3171/2012.1.PEDS11441.

© AANS, except where prohibited by US copyright law.

Headings

References

1

Asano EBenedek KShah AJuhász CShah JChugani DC: Is intraoperative electrocorticography reliable in children with intractable neocortical epilepsy?. Epilepsia 45:109110992004

2

Asano EJuhász CShah ASood SChugani HT: Role of subdural electrocorticography in prediction of long-term seizure outcome in epilepsy surgery. Brain 132:103810472009

3

Asano EMuzik OShah AJuhász CChugani DCSood S: Quantitative interictal subdural EEG analyses in children with neocortical epilepsy. Epilepsia 44:4254342003

4

Bengzon ARRasmussen TGloor PDussault JStephens M: Prognostic factors in the surgical treatment of temporal lobe epileptics. Neurology 18:7177311968

5

Benifla MOtsubo HOchi AWeiss SKDonner EJShroff M: Temporal lobe surgery for intractable epilepsy in children: an analysis of outcomes in 126 children. Neurosurgery 59:120312142006

6

Berg ATVickrey BGTesta FMLevy SRShinnar SDiMario F: How long does it take for epilepsy to become intractable? A prospective investigation. Ann Neurol 60:73792006

7

Berger MSGhatan SHaglund MMDobbins JOjemann GA: Low-grade gliomas associated with intractable epilepsy: seizure outcome utilizing electrocorticography during tumor resection. J Neurosurg 79:62691993

8

Bollo RJKalhorn SPCarlson CHaegeli VDevinsky OWeiner HL: Epilepsy surgery and tuberous sclerosis complex: special considerations. Neurosurg Focus 25:3E132008

9

Cascino GDTrenerry MRJack CR JrDodick DSharbrough FWSo EL: Electrocorticography and temporal lobe epilepsy: relationship to quantitative MRI and operative outcome. Epilepsia 36:6926961995

10

Chang EFChristie CSullivan JEGarcia PATihan TGupta N: Seizure control outcomes after resection of dysembryoplastic neuroepithelial tumor in 50 patients. Clinical article. J Neurosurg Pediatr 5:1231302010

11

Chang EFGabriel RAPotts MBGarcia PABarbaro NMLawton MT: Seizure characteristics and control after microsurgical resection of supratentorial cerebral cavernous malformations. Neurosurgery 65:31382009

12

Chen XSure UHaag AKnake SFritsch BMüller HH: Predictive value of electrocorticography in epilepsy patients with unilateral hippocampal sclerosis undergoing selective amygdalohippocampectomy. Neurosurg Rev 29:1081132006

13

Engel J JrVan Ness PRasmussen TOjemann LOutcome with respect to epileptic seizures. Engel J Jr: Surgical Treatment of the Epilepsies ed 2New YorkRaven Press1993. 609621

14

Fenyes IZoltan LFenyes G: Temporal epilepsies with deep-seated epileptogenic foci. Postoperative course. Arch Neurol 4:5595711961

15

Fiol MEGates JRTorres FMaxwell RE: The prognostic value of residual spikes in the postexcision electrocorticogram after temporal lobectomy. Neurology 41:5125161991

16

Gallentine WBMikati MA: Intraoperative electrocorticography and cortical stimulation in children. J Clin Neurophysiol 26:951082009

17

Gelinas JNBattison AWSmith SConnolly MBSteinbok P: Electrocorticography and seizure outcomes in children with lesional epilepsy. Childs Nerv Syst 27:3813902011

18

Gibbs FAAmador LRich CElectroencephalographic findings and therapeutic results in surgical treatment of psychomotor epilepsy. Baldwin MBailey P: Temporal Lobe Epilepsy Springfield, ILCharles C Thomas1958. 358367

19

Giulioni MRubboli GMarucci GMartinoni MVolpi LMichelucci R: Seizure outcome of epilepsy surgery in focal epilepsies associated with temporomesial glioneuronal tumors: lesionectomy compared with tailored resection. Clinical article. J Neurosurg 111:127512822009

20

Hemb MVelasco TRParnes MSWu JYLerner JTMatsumoto JH: Improved outcomes in pediatric epilepsy surgery: the UCLA experience, 1986–2008. Neurology 74:176817752010

21

Jayakar PDunoyer CDean PRagheb JResnick TMorrison G: Epilepsy surgery in patients with normal or nonfocal MRI scans: integrative strategies offer long-term seizure relief. Epilepsia 49:7587642008

22

Keene DLWhiting SVentureyra EC: Electrocorticography. Epileptic Disord 2:57632000

23

Kotsopoulos IAvan Merode TKessels FGde Krom MCKnottnerus JA: Systematic review and meta-analysis of incidence studies of epilepsy and unprovoked seizures. Epilepsia 43:140214092002

24

Marsh EDPeltzer BBrown MW IIIWusthoff CStorm PB JrLitt B: Interictal EEG spikes identify the region of electrographic seizure onset in some, but not all, pediatric epilepsy patients. Epilepsia 51:5926012010

25

McKhann GM IISchoenfeld-McNeill JBorn DEHaglund MMOjemann GA: Intraoperative hippocampal electrocorticography to predict the extent of hippocampal resection in temporal lobe epilepsy surgery. J Neurosurg 93:44522000

26

Morales Chacón LEstupiñán BLorigados Pedre LTrápaga Quincoses OGarcía Maeso ISanchez A: Microscopic mild focal cortical dysplasia in temporal lobe dual pathology: an electrocorticography study. Seizure 18:5936002009

27

Muacevic AUhl ESteiger HJReulen HJ: Accuracy and clinical applicability of a passive marker based frameless neuronavigation system. J Clin Neurosci 7:4144182000

28

Ogiwara HNordli DR JrDiPatri AJ JrAlden TDBowman RMTomita T: Pediatric epileptogenic gangliogliomas: seizure outcome and surgical results. Clinical article. J Neurosurg Pediatr 5:2712762010

29

Otsubo HHoffman HJHumphreys RPHendrick EBDrake JMHwang PA: Evaluation, surgical approach and outcome of seizure patients with gangliogliomas. Pediatr Neurosurg 16:2082121991

30

Palmini AGambardella AAndermann FDubeau Fda Costa JCOlivier A: Intrinsic epileptogenicity of human dysplastic cortex as suggested by corticography and surgical results. Ann Neurol 37:4764871995

31

Perry MSDunoyer CDean PBhatia SBavariya ARagheb J: Predictors of seizure freedom after incomplete resection in children. Neurology 75:144814532010

32

Pilcher WHSilbergeld DLBerger MSOjemann GA: Intraoperative electrocorticography during tumor resection: impact on seizure outcome in patients with gangliogliomas. J Neurosurg 78:8919021993

33

Rasmussen TB: Surgical treatment of complex partial seizures: results, lessons, and problems. Epilepsia 24:Suppl 1S65S761983

34

Rassi-Neto AFerraz FPCampos CRBraga FM: Patients with epileptic seizures and cerebral lesions who underwent lesionectomy restricted to or associated with the adjacent irritative area. Epilepsia 40:8568641999

35

Schramm J: Temporal lobe epilepsy surgery and the quest for optimal extent of resection: a review. Epilepsia 49:129613072008

36

Schwartz TIntraoperative electrocorticography has a limited role in the treatment of nonlesional medial temporal lobe epilepsy. Miller JWSilbergeld D: Epilepsy Surgery: Principles and Controversies LondonTaylor and Francis Books2005438441

37

Stefan HHopfengärtner RKreiselmeyer GWeigel DRampp SKerling F: Interictal triple ECoG characteristics of temporal lobe epilepsies: an intraoperative ECoG analysis correlated with surgical outcome. Clin Neurophysiol 119:6426522008

38

Sugano HShimizu HSunaga S: Efficacy of intraoperative electrocorticography for assessing seizure outcomes in intractable epilepsy patients with temporal-lobe-mass lesions. Seizure 16:1201272007

39

Tran TASpencer SSJavidan MPacia SMarks DSpencer DD: Significance of spikes recorded on intraoperative electrocorticography in patients with brain tumor and epilepsy. Epilepsia 38:113211391997

40

Tripathi MGarg AGaikwad SBal CSChitra SPrasad K: Intra-operative electrocorticography in lesional epilepsy. Epilepsy Res 89:1331412010

41

Van Gompel JJMeyer FBMarsh WRLee KHWorrell GA: Stereotactic electroencephalography with temporal grid and mesial temporal depth electrode coverage: does technique of depth electrode placement affect outcome? Clinical article. J Neurosurg 113:32382010

42

Van Gompel JJRubio JCascino GDWorrell GAMeyer FB: Electrocorticography-guided resection of temporal cavernoma: is electrocorticography warranted and does it alter the surgical approach? Clinical article. J Neurosurg 110:117911852009

43

Walker AELichtenstein RSMarshall C: A critical analysis of electrocorticography in temporal lobe epilepsy. Arch Neurol 2:1721821960

44

Wennberg RQuesney LFLozano AOlivier ARasmussen T: Role of electrocorticography at surgery for lesion-related frontal lobe epilepsy. Can J Neurol Sci 26:33391999

45

Wu JYSankar RLerner JTMatsumoto JHVinters HVMathern GW: Removing interictal fast ripples on electrocorticography linked with seizure freedom in children. Neurology 75:168616942010

TrendMD

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 5 5 5
Full Text Views 4 4 4
PDF Downloads 41 41 33
EPUB Downloads 0 0 0

PubMed

Google Scholar