Continuous EEG monitoring after brain tumor surgery

Abstract

Background Prolonged seizures generate cerebral hypoxia and increased intracranial pressure, resulting in an increased risk of neurological deterioration, increased long-term morbidity, and shorter survival. Seizures should be recognized early and treated promptly. The aim of the study was to investigate the occurrence of postoperative seizures in patients undergoing craniotomy for primary brain tumors and to determine if non-convulsive seizures could explain some of the postoperative neurological deterioration that may occur after surgery. Methods A single-center prospective study of 100 patients with suspected glioma. Participants were studied with EEG and video recording for at least 24 h after surgery. Results Seven patients (7%) displayed seizure activity on EEG recording within 24 h after surgery and another two patients (2%) developed late seizures. One of the patients with early seizures also developed late seizures. In five patients (5%), there were non-convulsive seizures. Four of these patients had a combination of clinically overt and non-convulsive seizures and in one patient, all seizures were non-convulsive. The non-convulsive seizures accounted for the majority of total seizure time in those patients. Non-convulsive seizures could not explain six cases of unexpected postoperative neurological deterioration. Postoperative ischemic lesions were more common in patients with early postoperative seizures. Conclusions Early seizures, including non-convulsive, occurred in 7% of our patients. Within this group, non-convulsive seizure activity had longer durations than clinically overt seizures, but only 1% of patients had exclusively non-convulsive seizures. Seizures were not associated with unexpected neurological deterioration. Electronic supplementary material The online version of this article (10.1007/s00701-019-03982-6) contains supplementary material, which is available to authorized users.

Time course of neurological deficits after surgery for primary brain tumours

“…The surgical procedure is described in detail earlier [13]. Briefly, tumour resection was done through craniotomy using microsurgery guided by neuronavigation and intraoperative ultrasound.…”

“…5-Amnolevulinic acid (5-ALA) (Gliolan, Medac Pharma, Varberg, Sweden) was used in 21 patients with presumed high-grade (contrast enhancing) tumours if total resection was the goal of surgery. After surgery, the patient was awakened in the operating theatre and brought to the postoperative neurointermediate ward, and EEG-and video monitoring was initiated [13]. A neurologic examination was performed by the responsible surgeon.…”

“…In a previous work [13], we examined the occurrences of epileptic seizures with continuous EEG monitoring after surgery for presumed primary brain tumours. We found that 7% of the patients displayed postoperative epileptic seizures the first 24 h after surgery [13]. However, in all 9 patients (9%) in this study with a delayed neurological deterioration, seizures were the proven (n = 5) or probable (n = 4) cause of the new deficits.…”

To Analyze the Application Value of Perioperative Nursing Care in Patients with Resected Brain Tumor Accompanied with Epileptic Symptoms under Cortical Electrocorticography Monitoring

“…With the improvement of medical concepts, the use of cortical EEG in monitoring and removing tumor and epileptic waves has been gradually applied in clinical practice. Its advantage is that those lesion complexes that cannot be observed in the naked eye can be removed under the guidance of cortical electrode, thus avoiding intraoperative residual lesions, effectively preventing postoperative intractable epilepsy, and greatly improving the clinical cure rate [ 17 – 20 ]. According to reports, patients with brain tumors have the highest incidence of epilepsy in patients with teratomas and lipomas, followed by oligodendroglioma, meningioma, poorly differentiated astrocytoma, cavernous hemangioma, and cholesteatoma [ 21 , 22 ].…”

Identification of Food/Nonfood Visual Stimuli from Event-Related Brain Potentials

“…Even though the methods of imaging (Magnetic Resonance Imaging (MRI), Functional Magnetic Resonance Imaging (fMRI), and Positron Emission Tomography (PET)) are very useful for showing changes in cerebral blood flow that occurred during cognitive processing, hemodynamic responses are insufficient to explain the temporal dynamics of fast electrophysiological activity in the neural network [6,7]. Electroencephalogram (EEG) has a high temporal resolution that allows measurement of the brain's electrical activity [8][9][10] and varies concerning the presence of visual, somatosensory, and auditory stimuli [1,11]. Event-Related Potential (ERP) recordings consist of sudden voltage fluctuations as a response to the stimulus [12,13].…”