Intraoperative electrocorticography‐guided microsurgical management for patients with onset of supratentorial neoplasms manifesting as epilepsy: a review of 65 cases

Abstract

Aim. We reviewed the surgical procedures guided by intraoperative electrocorticography and outcome of 65 patients with onset of supratentorial neoplasms manifesting as epilepsy. Method. Clinical data were obtained for 65 patients with supratentorial neoplasms who received surgery, with the aid of intraoperative electrocorticography to screen epileptogenic foci before and after removal of neoplasms, and depth electrodes when needed. According to electrocorticography findings, appropriate surgical procedures were performed to treat the epileptogenic foci. In the control group, 72 patients received simple lesionectomy. Postoperative seizure outcomes were documented and analysed retrospectively. Results. In the case group, 33 patients received lesionectomy only, while the other 32 patients underwent intraoperative electrocorticography‐guided tailored epilepsy surgery. In total, 57 patients (87.7%) in the case group and 38 patients (52.8%) in the control group were seizure‐free (Engel Class I). Comparing outcomes of patients with temporal lesions between the two groups, 80.0% patients (12/15) in the case group and 20.0% (3/15) in the control group were seizure‐free. Furthermore, comparing the seizure outcomes of patients who finally underwent tailored epilepsy surgery and simple lesionectomy (33 after electrocorticography and 72 without electrocorticography), intraoperative electrocorticography‐guided tailored epilepsy surgery demonstrated superiority over lesionectomy (Engel Class I; 87.5% vs. 63.8%, respectively). Conclusions. Electrocorticography plays an important role in the localisation of epileptogenic foci and evaluation of the effects of microsurgical procedures intraoperatively. Isolated lesionectomy is not usually sufficient for better postoperative seizure outcome. In addition, for patients with temporal tumours, especially in the non‐dominant hemisphere, a more aggressive strategy, such as an anterior temporal lobectomy, is recommended.

Early Epilepsy Surgery in Benign Cerebral Tumors: Avoid Your ‘Low-Grade’ Becoming a ‘Long-Term’ Epilepsy-Associated Tumor

“…However, preoperative seizure duration and the number and duration of ASMs were significantly higher in the ECoG-guided resection group than in the group without ECoG [ 31 ]. Others reported ECoG-guided tailored epilepsy surgery to be superior to lesionectomy alone in LEAT patients [ 32 , 33 ]. However, whether ECoG was preferentially utilized in cases involving more severe epilepsy or for lesions less amenable to gross-total resection—actors potentially confounding this result—could not be discerned given the lack of data disaggregation in the literature.…”

Epilepsy surgery for low-grade epilepsy-associated neuroepithelial tumor of temporal lobe: a single-institution experience of 61 patients

“…First, the influence of electrocorticogram (ECoG) on surgical outcome remains controversial [13][14][15]. Second, some studies suggested extended resection guided by presurgical evaluation and/or ECoG [13,[16][17][18], while other studies indicated no additional benefits obtained from extended resection [3,14,15,19,20]. Third, the location of LEAT in the lateral or mesial part may result in completely different surgical approach.…”

Clinical Relevance of Interictal Spikes in Tumor-Related Epilepsy: An Electrocorticographic Study

“…4 In contrast, an- Several previous studies have investigated the usefulness of irritative zone removal in tumor-related epilepsy. 2,7,8 However, those studies simply compared surgical outcomes of gross total tumor removal alone with those of extended surgery involving the removal of the irritative zone, and the spatial relationship between the interictal spikes and the resection volume has not been investigated, which may help to determine usefulness of interictal spikes recorded by ECoG in delineation of resection margin in tumor-related epilepsy. Regarding this issue, the extraoperative ECoG, rather than intraoperative ECoG, provide a unique opportunity to comprehensive comparison of spatial relationship between interictal spikes of ECoG and resection volume, since it could provide 3-dimensional interictal spike source locations in the brain model rather than the position of the electrodes on the 2-dimensional cortical surface.…”