A 360° electronic device for recording high-resolution intraoperative electrocorticography of the brain during awake craniotomy

Abstract

OBJECTIVEEpilepsy is common among patients with supratentorial brain tumors; approximately 40%–70% of patients with glioma develop brain tumor–related epilepsy (BTRE). Intraoperative localization of the epileptogenic zone during surgical tumor resection (real-time data) may improve intervention techniques in patients with lesional epilepsy, including BTRE. Accurate localization of the epileptogenic signals requires electrodes with high-density spatial organization that must be placed on the cortical surface during surgery. The authors investigated a 360° high-density ring-shaped cortical electrode assembly device, called the “circular grid,” that allows for simultaneous tumor resection and real-time electrophysiology data recording from the brain surface.METHODSThe authors collected data from 99 patients who underwent awake craniotomy from January 2008 to December 2018 (29 patients with the circular grid and 70 patients with strip electrodes), of whom 50 patients were matched-pair analyzed (25 patients with the circular grid and 25 patients with strip electrodes). Multiple variables were then retrospectively assessed to determine if utilization of this device provides more accurate real-time data and improves patient outcomes.RESULTSMatched-pair analysis showed higher extent of resection (p = 0.03) and a shorter transient motor recovery period during the hospitalization course (by approximately 6.6 days, p ≤ 0.05) in the circular grid patients. Postoperative versus preoperative Karnofsky Performance Scale (KPS) score difference/drop was greater for the strip electrode patients (p = 0.007). No significant difference in postoperative seizures between the 2 groups was present (p = 0.80).CONCLUSIONSThe circular grid is a safe, feasible tool that grants direct access to the cortical surgical surface for tissue resection while simultaneously monitoring electrical activity. Application of the circular grid to different brain pathologies may improve intraoperative epileptogenic detection accuracy and functional outcomes, while decreasing postoperative complications.

Influence of supramarginal resection on survival outcomes after gross-total resection of IDH–wild-type glioblastoma

“…Our experience has been to perform more awake craniotomies with direct cortical and subcortical real-time mapping and neuropsychological testing at the time of surgery to maximize resection and minimize potential neurological deficit, and no significant difference in postoperative KPS has been observed between patients with ≤ 0% SMR and those with > 0% SMR. 6,12,[38][39][40][41][42][43][44] Additionally, no significant differences in percentages of SMR were noted between patients with deep-seated versus cortical tumor, or between those with tumors in eloquent versus noneloquent areas.…”

IDH–wild-type glioblastoma cell density and infiltration distribution influence on supramarginal resection and its impact on overall survival: a mathematical model

“…Awake craniotomies with direct cortical and subcortical real-time mapping as well as in-depth neuropsychological testing during the procedure may help maximize resection within the illustrated beneficial SMR percentages for each tumor category and minimize potential neurological deficit. 9,[37][38][39][40][41][42][43][44][45]…”

Intraoperative Neuromonitoring During Resection of Gliomas Involving Eloquent Areas

“…Recently, with the development of biomedical engineering and materials science, Karim et al had developed a so-called “circular grid” electrode, which could enable tumor resection and 360° monitoring of cortical discharge activity at the same time. Compared with traditional strip electrodes, this state-of-the-art technique retains several advantages such as more accurate intraoperative epilepsy detection, larger resection rate, and better functional outcomes ( 47 ).…”