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Warsi NM, Mohammad AH, Zhang F, Wong SM, Yan H, Mansouri A, Ibrahim GM. Electrocorticography-Guided Resection Enhances Postoperative Seizure Freedom in Low-Grade Tumor-Associated Epilepsy: A Systematic Review and Meta-Analysis. Neurosurgery 2023; 92:18-26. [PMID: 36519857 DOI: 10.1227/neu.0000000000002182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 08/10/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Low-grade cerebral neoplasms are commonly associated with medically intractable epilepsy. Despite increasing evidence that epileptogenic brain regions commonly extend beyond visible tumor margins, the utility of extended surgical resections leveraging intraoperative electrocorticography (ECoG) remains unclear. OBJECTIVE To determine whether ECoG-guided surgery is associated with improved postoperative seizure control. METHODS We performed a systematic review and meta-analysis encompassing both adult and pediatric populations. The primary outcome measure was postoperative seizure freedom as defined by Engel class I outcome. Class I/II outcome served as a secondary measure. Relevant clinical and operative data were recorded. A random-effects meta-analysis based on the pooled odds ratio (OR) of seizure freedom was performed on studies that reported comparative data between ECoG-guided surgery and lesionectomy. RESULTS A total of 31 studies encompassing 1115 patients with medically refractory epilepsy met inclusion criteria. Seven studies reported comparative data between ECoG-guided surgery and lesionectomy for meta-analysis. Tumor resection guided by ECoG was associated with significantly greater postoperative seizure freedom (OR 3.95, 95% CI 2.32-6.72, P < .0001) and class I/II outcome (OR 5.10, 95% CI 1.97-13.18, P = .0008) compared with lesionectomy. Postoperative adverse events were rare in both groups. CONCLUSION These findings provide support for the utilization of ECoG-guided surgery to improve postoperative seizure freedom in cases of refractory epilepsy associated with low-grade neoplasms. However, this effect may be attenuated in the presence of concomitant cortical dysplasia, highlighting a need for improved presurgical and intraoperative monitoring for these most challenging cases of localization-related epilepsy.
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Affiliation(s)
- Nebras M Warsi
- Division of Neurosurgery, Department of Surgery, University of Toronto, Ontario, Canada.,Division of Neurosurgery, Hospital for Sick Children, University of Toronto, Ontario, Canada.,Department of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Amro H Mohammad
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | | | - Simeon M Wong
- Division of Neurosurgery, Hospital for Sick Children, University of Toronto, Ontario, Canada.,Department of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Han Yan
- Division of Neurosurgery, Department of Surgery, University of Toronto, Ontario, Canada.,Division of Neurosurgery, Hospital for Sick Children, University of Toronto, Ontario, Canada
| | - Alireza Mansouri
- Penn State Cancer Institute, Department of Neurosurgery, Penn State Health Milton S. Hershey Medical Center, Pennsylvania, USA
| | - George M Ibrahim
- Division of Neurosurgery, Department of Surgery, University of Toronto, Ontario, Canada.,Division of Neurosurgery, Hospital for Sick Children, University of Toronto, Ontario, Canada.,Department of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
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Arski ON, Wong SM, Warsi NM, Martire DJ, Ochi A, Otsubo H, Donner E, Jain P, Kerr EN, Smith ML, Ibrahim GM. Spectral changes following resective epilepsy surgery and neurocognitive function in children with epilepsy. J Neurophysiol 2021; 126:1614-1621. [PMID: 34550020 DOI: 10.1152/jn.00434.2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Decelerated resting cortical oscillations, high-frequency activity, and enhanced cross-frequency interactions are features of focal epilepsy. The association between electrophysiological signal properties and neurocognitive function, particularly following resective surgery, is, however, unclear. In the current report, we studied intraoperative recordings from intracranial electrodes implanted in seven children with focal epilepsy and analyzed the spectral dynamics both before and after surgical resection of the hypothesized seizure focus. The associations between electrophysiological spectral signatures and each child's neurocognitive profiles were characterized using a partial least squares analysis. We find that extent of spectral alteration at the periphery of surgical resection, as indexed by slowed resting frequency and its acceleration following surgery, is associated with baseline cognitive deficits in children. The current report provides evidence supporting the relationship between altered spectral properties in focal epilepsy and neuropsychological deficits in children. In particular, these findings suggest a critical role of disrupted thalamocortical rhythms, which are believed to underlie the spectral alterations we describe, in both epileptogenicity and neurocognitive function.NEW & NOTEWORTHY Spectral alterations marked by decelerated resting oscillations and ectopic high-frequency activity have been noted in focal epilepsy. We leveraged intraoperative recordings from chronically implanted electrodes pre- and postresection to understand the association between these electrophysiological phenomena and neuropsychological function. We find that the extent of spectral alteration, indexed by slowed resting frequency and its acceleration following resection, is associated with baseline cognitive deficits. These findings provide novel insights into neurocognitive impairments in focal epilepsy.
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Affiliation(s)
- Olivia N Arski
- Program in Neuroscience and Mental Health, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Simeon M Wong
- Program in Neuroscience and Mental Health, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada.,Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Nebras M Warsi
- Program in Neuroscience and Mental Health, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada.,Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada.,Division of Neurosurgery, Hospital for Sick Children, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Daniel J Martire
- Program in Neuroscience and Mental Health, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Ayako Ochi
- Division of Neurology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Hiroshi Otsubo
- Division of Neurology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth Donner
- Division of Neurology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Puneet Jain
- Division of Neurology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth N Kerr
- Division of Psychology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Mary Lou Smith
- Division of Psychology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - George M Ibrahim
- Program in Neuroscience and Mental Health, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.,Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada.,Division of Neurosurgery, Hospital for Sick Children, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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