Detection of after-discharges during intraoperative functional brain mapping in awake brain tumor surgery using a novel high-density circular grid

Tatum, William O.; McKay, Jake H.; ReFaey, Karim; Feyissa, Anteneh M.; Ryan, D.; Ritaccio, Anthony L.; Middlebrooks, Erik H.; Yelvington, Kirsten; Roth, Grayson; Acton, Emily K.; Grewal, Sanjeet S.; Chaichana, Kaisorn L.; Quiñones‐Hinojosa, Alfredo

doi:10.1016/j.clinph.2019.12.416

Cited by 12 publications

(5 citation statements)

References 40 publications

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“…One use of electrocorticography in epilepsy (or lesional) surgery is mapping areas of the cortex associated with interictal epileptiform discharges before tailoring surgical resection or suggesting postresection prognosis 50 . Electrocorticography is also used to monitor for afterdischarges ( figure 2-47 ) during direct electrocortical stimulation performed for functional brain mapping 51 . Language, motor, and sensory cortices are defined by using direct superficial or deep electrical stimulation directed by a wand handheld by the neurosurgeon.…”

Section: Electrocorticographymentioning

confidence: 99%

“…50 Electrocorticography is also used to monitor for afterdischarges (FIGURE during direct electrocortical stimulation performed for functional brain mapping. 51 Language, motor, and sensory cortices are defined by using direct superficial or deep electrical stimulation directed by a wand handheld by the neurosurgeon. Compared with intracranial EEG, intraoperative electrocorticography has brief recording periods, less sustained discomfort, and lower risk from electrode placement.…”

Section: Electrocorticographymentioning

confidence: 99%

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EEG Essentials

Tatum¹

2022

CONTINUUM: Lifelong Learning in Neurology

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PURPOSE OF REVIEW: EEG is the best study for evaluating the electrophysiologic function of the brain. The relevance of EEG is based on an accurate interpretation of the recording. Understanding the neuroscientific basis for EEG is essential. The basis for recording and interpreting EEG is both brain site-specific and technique-dependent to detect and represent a complex series of waveforms. Separating normal from abnormal EEG lies at the foundation of essential interpretative skills.RECENT FINDINGS: Seizures and epilepsy are the primary targets for clinical use of EEG in diagnosis, seizure classification, and management. Interictal epileptiform discharges on EEG support a clinical diagnosis of seizures, but only when an electrographic seizure is recorded is the diagnosis confirmed. New variations of normal waveforms, benign variants, and artifacts can mimic epileptiform patterns and are potential pitfalls for misinterpretation for inexperienced interpreters. A plethora of medical conditions involve nonepileptiform and epileptiform abnormalities on EEG along the continuum of people who appear healthy to those who are critically ill. Emerging trends in long-term EEG monitoring to diagnose, classify, quantify, and characterize patients with seizures have unveiled epilepsy syndromes in patients and expanded medical and surgical options for treatment. Advances in terminology and application of continuous EEG help unify neurologists in the diagnosis of nonconvulsive seizures and status epilepticus in patients with encephalopathy and prognosticate recovery from serious neurologic injury involving the brain. SUMMARY: After 100 years, EEG has retained a key role in the neurologist's toolkit as a safe, widely available, versatile, portable test of neurophysiology, and it is likely to remain at the forefront for patients with neurologic diseases. Interpreting EEG is based on qualitative review, and therefore, the accuracy of reporting is based on the interpreter's training, experience, and exposure to many new and older waveforms.

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Section: Electrocorticographymentioning

confidence: 99%

Section: Electrocorticographymentioning

confidence: 99%

EEG Essentials

Tatum¹

2022

CONTINUUM: Lifelong Learning in Neurology

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“…Along with these white matter tracts, real-time simulated electroencephalography or electrocorticography are being considered to monitor electrical discharges and epileptiform activity while a surgical trainee is stimulating the model. [41][42][43] Additional iterations also seek to introduce blood and cerebrospinal fluid circulation using mechanical pumps, which would replicate intraoperative complications such as vessel injury and seizures. 26 This represents a huge leap forward for the field, allowing even the most experienced surgeons to practice a perfect replica of their cases before operating.…”

Section: Future Advancementsmentioning

confidence: 99%

Three-Dimensionally Printed Surgical Simulation Tool for Brain Mapping Training and Preoperative Planning

Colaguori¹,

Marin-Mera²,

McDonnell³

et al. 2021

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BACKGROUND Brain mapping is the most reliable intraoperative tool for identifying surrounding functional cortical and subcortical brain parenchyma. Brain mapping procedures are nuanced and require a multidisciplinary team and a well-trained neurosurgeon. Current training methodology involves real-time observation and operation, without widely available surgical simulation. OBJECTIVE To develop a patient-specific, anatomically accurate, and electrically responsive biomimetic 3D-printed model for simulating brain mapping. METHODS Imaging data were converted into a 2-piece inverse 3D-rendered polyvinyl acetate shell forming an anatomically accurate brain mold. Functional and diffusion tensor imaging data were used to guide wire placement to approximate the projection fibers from the arm and leg areas in the motor homunculus. Electrical parameters were generated, and data were collected and processed to differentiate between the 2 tracts. For validation, the relationship between the electrical signal and the distance between the probe and the tract was quantified. Neurosurgeons and trainees were interviewed to assess the validity of the model. RESULTS Material testing of the brain component showed an elasticity modulus of 55 kPa (compared to 140 kPa of cadaveric brain), closely resembling the tactile feedback a live brain. The simulator's electrical properties approximated that of a live brain with a voltage-to-distance correlation coefficient of r2 = 0.86. Following 32 neurosurgeon interviews, ∼96% considered the model to be useful for training. CONCLUSION The realistic neural properties of the simulator greatly improve representation of a live surgical environment. This proof-of-concept model can be further developed to contain more complicated tractography, blood and cerebrospinal fluid circulation, and more in-depth feedback mechanisms.

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“…[5][6][7][8] Recently, our group developed a novel, high-density, hollow, 360 • circular array (PCT/US2018/039956), allowing us to maintain the array placed around the surgical corridor while operating through the interior aperture, monitoring for electrical abnormalities throughout the resection. [9][10][11] ABBREVIATIONS: ADs, after-discharges; BOLD, blood oxygenation level dependent; ECoG, electrocorticography; IDH, isocitrate dehydrogenase;…”

mentioning

confidence: 99%

Intraoperative Seizure Detection During Active Resection of Glioblastoma Through a Novel Hollow Circular Electrocorticography Array

Domingo

Vivas-Buitrago

Biase

et al. 2021

ONSURG

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BACKGROUND AND IMPORTANCE Data supporting the use of electrocorticography (ECoG) monitoring during electrical stimulation in awake craniotomies for resection of supratentorial neoplasms is robust, but its applicability during active resection is often limited by the inability to keep the array in place. Given the known survival benefit of gross total resection in glioma surgery, novel approaches to surgical monitoring are warranted to maximize safe resection and optimize surgical outcomes in patients with glioblastoma. CLINICAL PRESENTATION A 68-yr-old right-handed woman presented to the emergency department with confusion. Imaging studies revealed a bifrontal intra-axial brain lesion. She underwent a left-sided awake craniotomy procedure with cortical and subcortical mapping. During surgical resection, multiple electrographic seizures were detected on continuous ECoG monitoring with a customized 22-channel high-density hollow circular array. She remained without clinical evidence of seizures at 3 mo after surgery. CONCLUSION We report a unique case of serial electrographic seizures detected during continuous intraoperative ECoG monitoring during active surgical resection of a glioblastoma using a novel circular hollow array during an awake craniotomy. The use of continuous ECoG monitoring during active resection may provide additional data, with potential influence in outcomes for patients undergoing resection of high-grade glial neoplasms.

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Detection of after-discharges during intraoperative functional brain mapping in awake brain tumor surgery using a novel high-density circular grid

Cited by 12 publications

References 40 publications

EEG Essentials

EEG Essentials

Three-Dimensionally Printed Surgical Simulation Tool for Brain Mapping Training and Preoperative Planning

Intraoperative Seizure Detection During Active Resection of Glioblastoma Through a Novel Hollow Circular Electrocorticography Array

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