Reassessing the impact of intraoperative electrocorticography on postoperative outcome of patients undergoing standard temporal lobectomy for MRI-negative temporal lobe epilepsy
| Autor: | Richard W. Marsh, Fredric B. Meyer, Gregory A. Worrell, Elson L. So, William J. Perkins, Jamie J. Van Gompel, Sanjeet S. Grewal, Mohammed Ali Alvi, Cheolsu Shin, Jeffrey W. Britton, David B. Burkholder, Gregory D. Cascino |
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| Rok vydání: | 2018 |
| Předmět: |
Adult
medicine.medical_specialty Adolescent medicine.medical_treatment Kaplan-Meier Estimate Electroencephalography Temporal lobe 03 medical and health sciences Epilepsy Young Adult 0302 clinical medicine Postoperative Complications medicine Humans Epilepsy surgery Ictal Child Electrocorticography Anterior temporal lobectomy 030304 developmental biology Aged Proportional Hazards Models 0303 health sciences Intraoperative Care medicine.diagnostic_test business.industry Amygdalohippocampectomy Middle Aged medicine.disease Anterior Temporal Lobectomy Brain Waves Analgesics Opioid Treatment Outcome Epilepsy Temporal Lobe Radiology business 030217 neurology & neurosurgery |
| Zdroj: | Journal of neurosurgery. 132(2) |
| ISSN: | 1933-0693 |
| Popis: | OBJECTIVEAlmost 30% of the patients with suspected temporal lobe epilepsy (TLE) have normal results on MRI. Success rates for resection of MRI-negative TLE are less favorable, ranging from 36% to 76%. Herein the authors describe the impact of intraoperative electrocorticography (ECoG) augmented by opioid activation and its effect on postoperative seizure outcome.METHODSAdult and pediatric patients with medically resistant MRI-negative TLE who underwent standardized ECoG at the time of their elective anterior temporal lobectomy (ATL) with amygdalohippocampectomy between 1990 and 2016 were included in this study. Seizure recurrence comprised the primary outcome of interest and was assessed using Kaplan-Meier and multivariable Cox regression analysis plots based on distribution of interictal epileptiform discharges (IEDs) recorded on scalp electroencephalography, baseline and opioid-induced IEDs on ECoG, and extent of resection.RESULTSOf the 1144 ATLs performed at the authors’ institution between 1990 and 2016, 127 (11.1%) patients (81 females) with MRI-negative TLE were eligible for this study. Patients with complete resection of tissue generating IED recorded on intraoperative ECoG were less likely to have seizure recurrence compared to those with incomplete resection on univariate analysis (p < 0.05). No difference was found in seizure recurrence between patients with bilateral independent IEDs and unilateral IEDs (p = 0.15), presence or absence of opioid-induced epileptiform activation (p = 0.61), or completeness of resection of tissue with opioid-induced IEDs on intraoperative ECoG (p = 0.41).CONCLUSIONSThe authors found that incomplete resection of IED-generating tissue on intraoperative ECoG was associated with an increased chance of seizure recurrence. However, they found that induction of epileptiform activity with intraoperative opioid activation did not provide useful intraoperative data predictive of improving operative results for temporal lobectomy in MRI-negative epilepsy. |
| Databáze: | OpenAIRE |
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