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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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Warsi NM, Narvacan K, Donner E, Go C, Strantzas S, Ochi A, Otsubo H, Sharma R, Snead OC, Ibrahim GM. Supplementing Extraoperative Electrocorticography With Real-Time Intraoperative Recordings Using the Same Chronically Implanted Electrodes. Oper Neurosurg (Hagerstown) 2021; 20:559-564. [PMID: 33555026 DOI: 10.1093/ons/opab019] [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] [Received: 08/10/2020] [Accepted: 12/11/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The practice of intraoperative electrocorticography (iECoG) to guide resective epilepsy surgery is variable. Limitations of iECoG include variability in recordings from previously unsampled cortex, increased operative time and cost, and a lack of clear benefit to surgical decision-making. OBJECTIVE To describe a simple technique to supplement extraoperative intracranial recordings with real-time iECoG using the same chronically implanted electrodes that overcome some of these limitations. METHODS We describe the technical procedure, intraoperative findings, and outcomes of 7 consecutive children undergoing 2-stage resective epilepsy surgery with invasive subdural grid monitoring between January 2017 and December 2019. All children underwent placement of subdural grids, strips, and depth electrodes. Planned neocortical resection was based on extraoperative mapping of ictal and interictal recordings. During resection in the second stage, the same electrodes were used to perform real-time iECoG. RESULTS Real-time iECoG using this technique leads to modification of resection for 2 of the 7 children. The first was extended due to an electroencephalographic seizure from a distant electrode not part of the original resection plan. The second was restricted due to attenuation of epileptiform activity following a partial resection, thereby limiting the extent of a Rolandic resection. No infections or other adverse events were encountered. CONCLUSION We report a simple technique to leverage chronically implanted electrodes for real-time iECoG during 2-stage resective surgery. This technique presents fewer limitations than traditional approaches and may alter intraoperative decision-making.
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Affiliation(s)
- Nebras M Warsi
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Division of Neurosurgery, Department of Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Karl Narvacan
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Division of Neurosurgery, Department of Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Elizabeth Donner
- Department of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Cristina Go
- Department of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Samuel Strantzas
- Division of Neurosurgery, Department of Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ayako Ochi
- Department of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Hiroshi Otsubo
- Department of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Roy Sharma
- Department of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - O Carter Snead
- Department of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - George M Ibrahim
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Division of Neurosurgery, Department of Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
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Sommer B, Rampp S, Doerfler A, Stefan H, Hamer HM, Buchfelder M, Roessler K. Investigation of subdural electrode displacement in invasive epilepsy surgery workup using neuronavigation and intraoperative MRI. Neurol Res 2018; 40:811-821. [PMID: 29916770 DOI: 10.1080/01616412.2018.1484588] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVES One of the main obstacles of electrode implantation in epilepsy surgery is the electrode shift between implantation and the day of explantation. We evaluated this possible electrode displacement using intraoperative MRI (iopMRI) data and CT/MRI reconstruction. METHODS Thirteen patients (nine female, four male, median age 26 ± 9.4 years) suffering from drug-resistant epilepsy were examined. After implantation, the position of subdural electrodes was evaluated by 3.0 T-MRI and thin-slice CCT for 3D reconstruction. Localization of electrodes was performed with the volume-rendering technique. Post-implantation and pre-explantation 1.5 T-iopMRI scans were coregistered with the 3D reconstructions to determine the extent of electrode dislocation. RESULTS Intraoperative MRI at the time of explantation revealed a relevant electrode shift in one patient (8%) of 10 mm. Median electrode displacement was 1.7 ± 2.6 mm with a coregistration error of 1.9 ± 0.7 mm. The median accuracy of the neuronavigation system was 2.2 ± 0.9 mm. Six of twelve patients undergoing resective surgery were seizure free (Engel class 1A, median follow-up 37.5 ± 11.8 months). CONCLUSION Comparison of pre-explantation and post-implantation iopMRI scans with CT/MRI data using the volume-rendering technique resulted in an accurate placement of electrodes. In one patient with a considerable electrode dislocation, the surgical approach and extent was changed due to the detected electrode shift. ABBREVIATIONS ECoG: electrocorticography; EZ: epileptogenic zone; iEEG: invasive EEG; iopMRI: intraoperative MRI; MEG: magnetoencephalography; PET: positron emission tomography; SPECT: single photon emission computed tomography; 3D: three-dimensional.
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Affiliation(s)
- Bjoern Sommer
- a Department of Neurosurgery , University Hospital Erlangen , Erlangen , Germany
| | - Stefan Rampp
- a Department of Neurosurgery , University Hospital Erlangen , Erlangen , Germany
| | - Arnd Doerfler
- b Department of Neuroradiology , University Hospital Erlangen , Erlangen , Germany
| | - Hermann Stefan
- c Department of Neurology , Epilepsy Center, University Hospital Erlangen , Erlangen , Germany
| | - Hajo M Hamer
- c Department of Neurology , Epilepsy Center, University Hospital Erlangen , Erlangen , Germany
| | - Michael Buchfelder
- a Department of Neurosurgery , University Hospital Erlangen , Erlangen , Germany
| | - Karl Roessler
- a Department of Neurosurgery , University Hospital Erlangen , Erlangen , Germany
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Randazzo MJ, Kondylis ED, Alhourani A, Wozny TA, Lipski WJ, Crammond DJ, Richardson RM. Three-dimensional localization of cortical electrodes in deep brain stimulation surgery from intraoperative fluoroscopy. Neuroimage 2015; 125:515-521. [PMID: 26520771 DOI: 10.1016/j.neuroimage.2015.10.076] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 10/09/2015] [Accepted: 10/25/2015] [Indexed: 11/28/2022] Open
Abstract
Electrophysiological recordings from subdural electrocorticography (ECoG) electrodes implanted temporarily during deep brain stimulation (DBS) surgeries offer a unique opportunity to record cortical activity for research purposes. The optimal utilization of this important research method relies on accurate and robust localization of ECoG electrodes, and intraoperative fluoroscopy is often the only imaging modality available to visualize electrode locations. However, the localization of a three-dimensional electrode position using a two-dimensional fluoroscopic image is problematic due to the lost dimension orthogonal to the fluoroscopic image, a parallax distortion implicit to fluoroscopy, and variability of visible skull contour among fluoroscopic images. Here, we present a method to project electrodes visible on the fluoroscopic image onto a reconstructed cortical surface by leveraging numerous common landmarks to translate, rotate, and scale coregistered computed tomography (CT) and magnetic resonance imaging (MRI) reconstructed surfaces in order to recreate the coordinate framework in which the fluoroscopic image was acquired, while accounting for parallax distortion. Validation of this approach demonstrated high precision with an average total Euclidian distance between three independent reviewers of 1.65±0.68mm across 8 patients and 82 electrodes. Spatial accuracy was confirmed by correspondence between recorded neural activity over sensorimotor cortex during hand movement. This semi-automated interface reliably estimates the location of temporarily implanted subdural ECoG electrodes visible on intraoperative fluoroscopy to a cortical surface.
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Affiliation(s)
- Michael J Randazzo
- Brain Modulation Laboratory, Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Efstathios D Kondylis
- Brain Modulation Laboratory, Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Ahmad Alhourani
- Brain Modulation Laboratory, Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Thomas A Wozny
- Brain Modulation Laboratory, Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Witold J Lipski
- Brain Modulation Laboratory, Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Donald J Crammond
- Brain Modulation Laboratory, Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - R Mark Richardson
- Brain Modulation Laboratory, Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA; Department of Neurobiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Center for the Neural Basis of Cognition, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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