Occurence of Epileptic Seizures during Intraoperative Brain Stimulation – Our Experience


Authors: T. Galanda 1;  J. Bullová 2;  M. Klúzová 1;  J. Mištinová 3;  M. Galanda 1
Authors‘ workplace: Neurochirurgická klinika SZU a FNsP F. D. Roosevelta, Banská Bystrica 1;  Oddelenie anestéziológie a intenzívnej medicíny FNsP F. D. Roosevelta, Banská Bystrica 2;  I. rádiologická klinika LF UK a UN Bratislava 3
Published in: Cesk Slov Neurol N 2012; 75/108(6): 748-753
Category: Short Communication

Poďakovanie Za štatistické spracovanie chceme poďakovať MUDr. Petrovi Jombíkovi, PhD., z neurologického odd. zvolenskej nemocnice.

Overview

Aim of the study:
To evaluate the relationship between intraoperative epileptic seizures evoked by direct electric stimulation of the brain and symptomatic epilepsy and parameters of the stimulation.

Methods:
The authors present monocentric retrospective analysis of 106 patients (50 men, 56 woman), in the age 15–82 years (average 52 years) who underwent surgery for pathological lesions localized within or near eloquent regions of the brain (low-grade glioma – 17, high-grade glioma – 34, metastasis – 29, meningioma – 19, others – 7) with utilization of direct cortical and subcortical stimulation at the authors’ institution between 2000–2009. For intraoperative mapping and monitoring of central structures of the brain continuous biphasic bipolar stimulation was used with frequency 100 or 50 Hz, pulse duration 1 ms, maximum intensity up to 18 mA, or stimulation with train of 5 pulses, interstimulus interval 2–4 ms, pulse width 0.4 ms, maximum intensity up to 30 mA, and repetition of trains 1 or 5 Hz. Evoked activity in contralateral muscles was monitored by EMG recording or by visual observation.

Results:
When patients with low-grade glioma had symptomatic epilepsy before operation, the risk of induction of intraoperative epileptic seizure was significantly higher (p = 0.06), in comparison to patients without epileptic seizure preoperatively or to patients with other pathologic lesion of the brain. Continuous stimulation with frequency 100 Hz and train with 5 Hz repetition rate evoked intraoperative focal epileptic seizures more often than continuous stimulation with frequency 50 Hz and train with 1 Hz repetition rate. However differences were not statistically important.

Conclusion:
The authors found significantly higher incidence of intraoperative focal epileptic seizures in patients with low grade glioma who had manifested epileptic seizures preoperatively.

Key words:
direct cortical stimulation – motor evoked potentials – stimulation induced seizures – symptomatic epilepsy


Sources

1. Berger MS, Hadjipanayis CG. Surgery of intrinsic cerebral tumors. Neurosurgery 2007; 61 (Suppl 1): 279–305.

2. Sartorius CJ, Wright G. Intraoperative brain mapping in a community setting-technical considerations. Surg Neurol 1997; 47(4): 380–388.

3. Stejskal L. Intraoperačni stimulačni monitorace v neurochirurgii. Praha: Grada Publishing 2006: 104.

4. Bartoš R, Sameš M, Vachata P, Červenka M, Jech R, Vymazal J et al. Výsledky a tolerance „awake“ resekcí mozkovýchch nádorů. Cesk Slov Neurol N 2005; 68/101(1): 39–45.

5. Cee J, Sameš M, Bartoš R, Vachata P, Vaněk P, Kašperek J et al. Peroperační monitorace motorických evokovaných odpovědí za užiti transkranialní elektrické stimulace – naše první klinické zkušenosti. Cesk Slov Neurol N 2006; 69/102(5): 365–380.

6. Sarnthein J, Bozinov O, Melone AG, Bertalanffy H. Motor evoked potentials (MEP) during brainstem surgery to preserve corticospinal function. Acta Neurochir 2011; 153(9): 1753–1759

7. Duffau H, Lopes M, Arthuis F, Bitar A, Sichez JP, Van Effenterre R et al. Contribution of intraoperative electrical stimulations in surgery of low grade gliomas: a comparative study between two series without (1985–96) and with (1996–2003) functional mapping in the same institution. J Neurol Neurosurg Psychiatry 2005; 76(6): 845–851.

8. Berger MS. Lesions in functional (“eloquent”) cortex and subcortical white mater. Clin Neurosurg 1994; 41: 444–463.

9. Ostrý S, Stejskal L. Evokované odpovědi a elektromyografie v intraoperačni monitoraci v neurochirurgii. Cesk Slov Neurol N 2010; 73/106(1): 8–19.

10. Szelenyi A, Bello L, Duffau H, Fava E, Feigl GC, Galanda M et al. Intraoperative electrical stimulation in awake craniotomy: methodological aspects of current practice. Neurosurg Focus 2010; 28(2): E7.

11. Berger MS, Ojemann GA, Lettich E. Neurophysiological monitoring during astrocytoma surgery. Neurosurg Clin N Am 1990; 1(1): 65–80.

12. Galanda M, Babicová A, Patráš F, Šulaj J, Béreš A. Peroperačná elektrická stimulácia pri operáciách v centrálnych oblastiach mozgu a v mieche. Cesk Slov Neurol N 2001; 64/67(6): 338–343.

13. Kombos T, Suess O, Ciklatekerlio O, Brock M. Monitoring of intraoperative motor evoked poten­tials to increase the safety of surgery in and around the motor cortex. J Neurosurg 2001; 95(4): 608–614.

14. Duffau H, Capelle L, Denvil D, Sichez N, Gatignol P, Taillandier L et al. Usefulness of intraoperative electrical subcortical mapping during surgery for low--grade gliomas located within eloquent brain regions: functional results in a consecutive series of 103 pa­tients. J Neurosurg 2003; 98(4): 764–778.

15. Nossek E, Korn A, Shahar T, Kanner AA, Yaffe H, Marcovici D et al. Intraoperative mapping and monitoring of the corticospinal tracts with neurophy­siological assessment and 3-dimensional ultrasonography-based navigation. J Neurosurg 2011; 114(4): 738–746.

16. Sartorius CJ, Berger MS. Rapid termination of intraoperative stimulation-evoked seizures with application of cold Ringer’s lactate to the cortex. Technical note. J Neurosurg 1998; 88(2): 349–351.

17. Jahangiri FR, Sherman JH, Sheehan J, Shaffrey M, Dumont AS, Vengrow M et al. Limiting the current density during localization of the primary motor cortex by using a tangential-radial cortical somatosensory evoked potentials model, direct electrical cortical stimulation, and electrocorticography. Neurosurgery 2011; 69(4): 893–898.

18. Galanda M. Intraoperačné neurofyziologické monitorovanie. In: Haruštiak S (ed). Principy chirurgie II. Bratislava: Slovak Academic Press 2010: 26–30.

19. Yingling CD, Ojemann S, Dodson B, Harrington MJ, Berger MS. Identification of motor pathways during tumor surgery facilitated by multichannel electromyographic recording. J Neurosurg 1999; 91(6): 922–927.

20. Zentner J, Hufnagel A, Pechstein U, Wolf HK, Schramm J. Functional results after resective procedures involving the supplementary motor area. J Neurosurg 1996; 85(4): 542–549.

21. Motamedi GK, Okunola O, Kalhorn ChG, Mostofi N, Mizuno-Matsumoto Y, Yong-won Cho et al. Afterdischarges during cortical stimulation at different frequencies and intensities. Epilepsy Research 2007; 77(1): 65–69.

22. Lee HW, Webber WR, Crone N, Miglioretti DL, Lesser RP. When is electrical cortical stimulation more likely to produce afterdischarges? Clin Neurophysiol 2010; 121(1): 14–20.

23. Pouratian N, Cannestra AF, Bookheimer SY, Mar-tin NA, Toga AW. Variability of intraoperative electrocortical stimulation mapping parameters across and within individuals. J Neurosurg 2004; 101(3): 458–466.

24. Duffau H, Gatignol P, Mandonnet E, Capelle L, Taillandier L. Intraoperative subcortical stimulation mapping of language pathways in a consecutive series of 115 patients with Grade II glioma in the left dominant hemisphere. J Neurosurg 2008; 109(3): 461–471.

25. Uematsu S, Lesser R, Fisher RS, Gordon B, Hara K, Krauss GL et al. Motor and sensory cortex in humans: topography studied with chronic subdural stimulation. Neurosurgery 1992; 31(1): 59–71.

26. Sanai N, Berger MS. Intraoperative stimulation techniques for functional pathway preservation and glioma resection Neurosurg Focus 2010; 28(2): E1.

27. Ilmberger J, Eisner W, Schmid U, Reulen HJ. Performance in picture naming and word comprehension: evidence for common neuronal substrates from intraoperative language mapping. Brain Lang 2001; 76(2): 111–118.

28. Kombos T, Süss O. Neurophysiological basis of direct cortical stimulation and applied neuroanatomy of the motor cortex: a review. Neurosurg Focus 2009; 27(4): E3.

29. Gil-Robles S, Duffau H. Surgical management of World Health Organization Grade II gliomas in eloquent areas: the necessity of preserving a margin around functional structures Neurosurg Focus 2010; 28(2): E8.

30. Bartoš R, Vachata P, Hejčl A, Zolal A, Malucelli A, Radovnický T et al. Vliv funkčního mapování na výsledky operací nízkostupňových gliomů WHO grade II. Cesk Slov Neurol N 2011; 74/107(3): 292–298.

31. Šteňo A, Šteňová V, Bellan V, Hollý V, Šurkala J, Šteňo J et al. „Awake“ resekcia supratentoriálnych low-grade gliomov lokalizovaných vo vnútri alebo v priamom kontakte s elokventnými oblasťami. Cesk Slov Neurol N 2011; 74/107(5): 539–549.

Labels
Paediatric neurology Neurosurgery Neurology

Article was published in

Czech and Slovak Neurology and Neurosurgery

Issue 6

2012 Issue 6

Most read in this issue

This topic is also in:


Login
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account