Continuous Intraoperative Neurophysiological Monitoring of the Motor Pathways Using Depth Electrodes During Surgical Resection of an Epileptogenic Lesion: A Novel Technique
| Autor: | David Cabrera, Katie L Bullinger, Ioannis Karakis, Jon T. Willie, Denise F Chen |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Intraoperative Neurophysiological Monitoring Efferent Pathways Stereoelectroencephalography 030218 nuclear medicine & medical imaging 03 medical and health sciences 0302 clinical medicine Medicine Humans Epilepsy surgery Electrocorticography medicine.diagnostic_test Supplementary motor area business.industry Electroencephalography Electrodes Implanted medicine.anatomical_structure Hemiparesis Surgery Female Neurology (clinical) Radiology Primary motor cortex medicine.symptom Neoplasm Recurrence Local business 030217 neurology & neurosurgery Motor cortex Intraoperative neurophysiological monitoring |
| Zdroj: | Operative neurosurgery (Hagerstown, Md.). 20(5) |
| ISSN: | 2332-4260 |
| Popis: | Background and importance Intraoperative neurophysiological monitoring of the motor pathways during epilepsy surgery is essential to safely achieve maximal resection of the epileptogenic zone. Motor evoked potential (MEP) recording is usually performed intermittently during resection using a handheld stimulator or continuously through an electrode array placed on the motor cortex. We present a novel variation of continuous MEP acquisition through previously implanted depth electrodes in the perirolandic cortex. Clinical presentation A 60-yr-old woman with a history of a left frontal meningioma (World Health Organization [WHO] grade II) treated with surgical resection and radiation presented with residual right hemiparesis and refractory epilepsy. Imaging demonstrated a perirolandic lesion with surrounding edema and mass effect in the prior surgical site, suspicious for radiation necrosis versus tumor recurrence. Presurgical electrocorticography (ECoG) with orthogonal, stereotactically implanted depth electrodes (stereoelectroencephalography [SEEG]) of the perirolandic cortex captured seizure onsets from the supplementary motor area (SMA) and primary motor cortex (PMC). The patient underwent a left frontal craniotomy for repeat resection and tissue diagnosis. Intraoperative ECoG and MEPs were obtained continuously with direct cortical stimulation through the indwelling SEEG electrodes in the PMC. Maximal resection was achieved with preservation of direct cortical MEPs and without deterioration of her baseline hemiparesis. Biopsy revealed radiation necrosis. At 30-mo follow-up, the patient had only rare seizures (Engel class IIB). Conclusion Intraoperative cortical MEP acquisition through implanted SEEG electrode arrays is a potentially safe and effective alternative approach to continuously monitor the motor pathways during the resection of a perirolandic epileptogenic lesion, without the need for surgical interruptions. |
| Databáze: | OpenAIRE |
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