Krasimir Minkin1, Kaloyan Gabrovski2, Petar Karazapryanov2, Yoana Milenova3, Stanimir Sirakov4, Vasil Karakostov2, Kiril Romanski5, Petia Dimova2. 1. Department of Neurosurgery, University Hospital "St. Ivan Rilski", Sofia, Bulgaria. Electronic address: minkin@abv.bg. 2. Department of Neurosurgery, University Hospital "St. Ivan Rilski", Sofia, Bulgaria. 3. Department of Neurology, University Hospital "St. Ivan Rilski", Sofia, Bulgaria. 4. Department of Interventional Radiology, University Hospital "St. Ivan Rilski", Sofia, Bulgaria. 5. Department of Neurosurgery, Military Medical Academy, Sofia, Bulgaria.
Abstract
BACKGROUND: Awake craniotomy (AC) and direct electrical stimulation (DES) emerged together with epilepsy surgery more than 80 years ago. The goal of our study was to evaluate the benefits of awake surgery in patients with drug-resistant epilepsy due to focal cortical dysplasia (FCD) affecting eloquent areas. METHODS: Our material included 95 patients with drug-resistant epilepsy and FCD, who were operated on between January 2009 and December 2018. These 95 patients were assigned into 3 groups - AC; general anesthesia (GA) with intraoperative neuromonitoring (IONM); GA without IONM. We investigated the following variables: age at surgery, lesion side, eloquent cortex involvement, brain mapping success rate, epilepsy surgery success rate, intraoperative complications, postoperative complications and intraoperative changes of the preoperative resection plan according to results of the brain mapping by direct electrical stimulation (DES). RESULTS: We found statistically significant differences between the AC and GA groups in the mean age at operation, lesion side, eloquent localization and postoperative transient neurological deficit. Seizure outcome in the AC was satisfactory (71% complete seizure control) and comparable to the seizure outcome in the GA groups. Our preoperative plan was changed because of functional constraints in 6 patients (43%) operated on during AC. CONCLUSIONS: Awake craniotomy during epilepsy surgery for FCD in eloquent areas may change the preoperative plan. The good rate of postoperative seizure control and the absence of permanent postoperative neurological deficit in our series is the main proof that AC is a useful tool in patients with FCD involving the eloquent cortex.
BACKGROUND: Awake craniotomy (AC) and direct electrical stimulation (DES) emerged together with epilepsy surgery more than 80 years ago. The goal of our study was to evaluate the benefits of awake surgery in patients with drug-resistant epilepsy due to focal cortical dysplasia (FCD) affecting eloquent areas. METHODS: Our material included 95 patients with drug-resistant epilepsy and FCD, who were operated on between January 2009 and December 2018. These 95 patients were assigned into 3 groups - AC; general anesthesia (GA) with intraoperative neuromonitoring (IONM); GA without IONM. We investigated the following variables: age at surgery, lesion side, eloquent cortex involvement, brain mapping success rate, epilepsy surgery success rate, intraoperative complications, postoperative complications and intraoperative changes of the preoperative resection plan according to results of the brain mapping by direct electrical stimulation (DES). RESULTS: We found statistically significant differences between the AC and GA groups in the mean age at operation, lesion side, eloquent localization and postoperative transient neurological deficit. Seizure outcome in the AC was satisfactory (71% complete seizure control) and comparable to the seizure outcome in the GA groups. Our preoperative plan was changed because of functional constraints in 6 patients (43%) operated on during AC. CONCLUSIONS: Awake craniotomy during epilepsy surgery for FCD in eloquent areas may change the preoperative plan. The good rate of postoperative seizure control and the absence of permanent postoperative neurological deficit in our series is the main proof that AC is a useful tool in patients with FCD involving the eloquent cortex.
Authors: Bayron A Sandoval-Bonilla; André Palmini; Eliseu Paglioli; Alejandro Monroy-Sosa; Maria F De la Cerda-Vargas; Job J Rodríguez-Hernández; Victor R Chávez-Herrera; Sara P Perez-Reyes; Fernando C Castro-Prado; Samuel Perez-Cardenas; Josafat J Sánchez-Dueñas; Lucero N Lagunes-Padilla Journal: J Neurosurg Case Lessons Date: 2022-03-07