Intraoperative seizures occurrence in cortical mapping of eloquent areas

Abstract

The effect of structural epilepsy on the frequency of intraoperative convulsive seizures is assessed when mapping functionally significant areas of the cerebral cortex during resection of intracerebral neoplasms. The work is based on the analysis of the results of intraoperative neurophysiological studies at the Polenov Neurosurgical Institute. For the period 2019–2020 87 intraoperative mappings of eloquent cortex were carried out during resections of intracerebral neoplasms: 79 mappings of the motor cortex and 16 mappings of auditory-speech areas during operations with awakening. When mapping the motor zones of the cortex, the frequency of seizures was 5.1%, while mapping the auditory-speech zones with awakening — 18.75%. The division of cases of intraoperative convulsive seizures into two groups: seizures arising from motor mapping and seizures associated with the mapping of auditory zones — reflects differences in factors that affect the excitability of the cerebral cortex. In motor mapping, stimulation occurs against the background of general anesthesia, unlike waking operations. The intensity of stimulation in auditory mapping is higher than in motor mapping in motor mapping. Formally, the current used in motor mapping is significantly higher than in mapping auditory zones. In general, with the development of intraoperative convulsive seizures, the current intensity of cortical stimulation does not exceed the average values required to stimulate functionally significant cortical zones. The presence of epileptic syndrome in patients with intracerebral tumors cannot be considered as a predictor of intraoperative seizure development when performing motor mapping under general anesthesia as well as during surgery with awakening for mapping of motor or auditory verbal zones.

Keywords

intraoperative neurophysiological monitoring / motor mapping / structural epilepsy / neurophysiology / neurosurgery / eloquent cortex

References

[1] Alexandrov MV, Chikurov AA, Toporkova OA, et al. Nejrofiziologicheskij intraoperacionny`j monitoring v nejroxirurgii. St. Petersburg: Spetslit LLC; 2019. (In Russ.).

[2] Александров М.В., Чикуров А.А., Топоркова О.А., и др. Нейрофизиологический интраоперационный мониторинг в нейрохирургии. СПб.: СпецЛит, 2019.

[3] Saito T, Muragaki Y, Maruyama T, et al. Intraoperative functional mapping and monitoring during glioma surgery. Neurol Med Chir (Tokyo). 2014;55(1):1–13. DOI: 10.2176/nmc.ra.2014-0215

[4] Saito T., Muragaki Y., Maruyama T., et al. Intraoperative functional mapping and monitoring during glioma surgery // Neurol. Med. Chir. (Tokyo). 2014. Vol. 55. No. 1. P. 1–13. DOI: 10.2176/nmc.ra.2014-0215

[5] Simon MV. Intraoperative neurophysiologic sensorimotor mapping-a review. J Neurol Neurophysiol. 2013;4(2). DOI: 10.4172/2155-9562.s3-002

[6] Simon M.V. Intraoperative neurophysiologic sensorimotor mapping-a review // J. Neurol. Neurophysiol. 2013. Vol. 4. No. 2. DOI: 10.4172/2155-9562.s3-002

[7] De Witt Hamer PC, Robles SG, Zwinderman AH, et al. Impact of intraoperative stimulation brain mapping on glioma surgery outcome: a meta-analysis. J Clin Oncol. 2012;30(20):2559–2565. DOI: 10.1200/JCO.2011.38.4818

[8] De Witt Hamer P.C., Robles S.G., Zwinderman A.H., et al. Impact of intraoperative stimulation brain mapping on glioma surgery outcome: a meta-analysis // J. Clin. Oncol. 2012. Vol. 30. No. 20. P. 2559–2565. DOI: 10.1200/JCO.2011.38.4818

[9] Dineen J, Simon MV. Neurophysiological tests in the operating room. In: Simon MV., ed. Intraoperative Neurophysiology: A comprehensive guide to monitoring and mapping. NY: Springer Publishing Company, Demos Medical; 2019:1–57.

[10] Dineen J., Simon M.V. Neurophysiological tests in the operating room. In: Simon M.V., ed. Intraoperative Neurophysiology: A comprehensive guide to monitoring and mapping. NY: Springer Publishing Company, Demos Medical, 2019. P. 1–57.

[11] Ulitin AYu, Alexandrov MV, Malyshev SM, et al. Efficacy of intraoperative motor mapping for resection of brain tumors located in the central gyrus region. Russian Neurosurgical Journal Named After Professor Polenov. 2017;9(1):57–62. (In Russ.).

[12] Улитин А.Ю., Александров М.В., Малышев С.М., и др. Эффективность интраоперационного моторного картирования при резекции опухолей центральных извилин // Российский нейрохирургический журнал им. проф. А.Л. Поленова. 2017. Т. 9. № 1 C. 57–62.

[13] Ilmberger J, Ruge M, Kreth F-W, et al. Intraoperative mapping of language functions: a longitudinal neurolinguistic analysis. J Neurosurg. 2008;109(4):583–592. DOI: 10.3171/JNS/2008/109/10/0583

[14] Ilmberger J., Ruge M., Kreth F.-W., et al. Intraoperative mapping of language functions: a longitudinal neurolinguistic analysis // J. Neurosurg. 2008. Vol. 109. No. 4. P. 583–592. DOI: 10.3171/JNS/2008/109/10/0583

[15] Picht T, Kombos T, Gramm HJ, et al. Multimodal protocol for awake craniotomy in language cortex tumour surgery. Acta Neurochir (Wien). 2006;148(2):127–138. DOI: 10.1007/s00701-005-0706-0

[16] Picht T., Kombos T., Gramm H.J., et al. Multimodal protocol for awake craniotomy in language cortex tumour surgery // Acta Neurochir. (Wien). 2006. Vol. 148. No. 2. P. 127–138. DOI: 10.1007/s00701-005-0706-0

[17] Simon MV. An introduction to functional mapping. In: Simon MV, ed. Intraoperative Neurophysiology: A comprehensive guide to monitoring and mapping. NY: Springer Publishing Company, Demos Medical; 2019:235–244.

[18] Simon M.V. An introduction to functional mapping. In: Simon M.V., ed. Intraoperative Neurophysiology: A comprehensive guide to monitoring and mapping. NY: Springer Publishing Company, Demos Medical, 2019. P. 235–244.

[19] 10. Zyryanov A, Zelenkova V, Malyutina S, Stupina E. The contributions of the arcuate fasciculus segments to language processing: evidence from brain tumor patients. Russ J Cogn Sci. 2019;6(1):25–37.

[20] Zyryanov A., Zelenkova V., Malyutina S., Stupina E. The contributions of the arcuate fasciculus segments to language processing: evidence from brain tumor patients // Russ. J. Cogn. Sci. 2019. Vol. 6. No. 1. P. 25–37.

[21] Lesser RP, Lee HW, Webber WRS, et al. Short-term variations in response distribution to cortical stimulation. Brain. 2008;131(6):1528–1539. DOI: 10.1093/brain/awn044

[22] Lesser R.P., Lee H.W., Webber W.R.S., et al. Short-term variations in response distribution to cortical stimulation // Brain. 2008. Vol. 131. No. 6. P. 1528–1539. DOI: 10.1093/brain/awn044

[23] Spena G, Schucht P, Seidel K, et al. Brain tumors in eloquent areas: A European multicenter survey of intraoperative mapping techniques, intraoperative seizures occurrence, and antiepileptic drug prophylaxis. Neurosurg Rev. 2017;40(2). DOI: 10.1007/s10143-016-0771-2

[24] Spena G., Schucht P., Seidel K., et al. Brain tumors in eloquent areas: A European multicenter survey of intraoperative mapping techniques, intraoperative seizures occurrence, and antiepileptic drug prophylaxis // Neurosurg. Rev. 2017. Vol. 40. No. 2. DOI: 10.1007/s10143-016-0771-2.

[25] Simon MV, Michaelides C, Wang S, et al. The effects of EEG suppression and anesthetics on stimulus thresholds in functional cortical motor mapping. Clin Neurophysiol. 2010;121(5). DOI: 10.1016/j.clinph.2010.01.002

[26] Simon M.V., Michaelides C., Wang S., et al. The effects of EEG suppression and anesthetics on stimulus thresholds in functional cortical motor mapping // Clin. Neurophysiol. 2010. Vol. 121. No. 5. DOI: 10.1016/j.clinph.2010.01.002

[27] Szelényi A, Joksimovič B, Seifert V. Intraoperative risk of seizures associated with transient direct cortical stimulation in patients with symptomatic epilepsy. J Clin Neurophysiol. 2007;24(1). DOI: 10.1097/01.wnp.0000237073.70314.f7

[28] Szelényi A., Joksimovič B., Seifert V. Intraoperative risk of seizures associated with transient direct cortical stimulation in patients with symptomatic epilepsy // J. Clin. Neurophysiol. 2007. Vol. 24. No. 1. DOI: 10.1097/01.wnp.0000237073.70314.f7

[29] Spena G, Garbossa D, Panciani PP, et al. Purely subcortical tumors in eloquent areas: Awake surgery and cortical and subcortical electrical stimulation (CSES) ensure safe and effective surgery. Clin Neurol Neurosurg. 2013;115(9):1595–1601. DOI: 10.1016/j.clineuro.2013.02.006

[30] Spena G., Garbossa D., Panciani P.P., et al. Purely subcortical tumors in eloquent areas: Awake surgery and cortical and subcortical electrical stimulation (CSES) ensure safe and effective surgery // Clin. Neurol. Neurosurg. 2013. Vol. 115. No. 9. P. 1595–1601. DOI: 10.1016/j.clineuro.2013.02.006

RIGHTS & PERMISSIONS

Toporkova O.A., Aleksandrov M.V., Tastanbekov M.M.