Authors :
Presenting Author: Brin Freund, MD – Mayo Clinic Florida
Sanjeet Grewal, MD – Mayo Clinic Florida; Anteneh Feyissa, MD – Mayo Clinic Florida; Aafreen khan, MD – Mayo Clinic Florida; Erik Middlebrooks, MD – Mayo Clinic Florida; Joseph Sirven, MD – Mayo Clinic Florida; Alfredo Quinones-Hinojosa, MD – Mayo Clinic Florida; William Tatum, DO – Mayo Clinic Florida
Rationale:
Awake Craniotomy (AC) with electrocorticography (ECoG) is a technique used for resection of lesions involving eloquent brain regions. Though factors related to intraoperative and long-term seizures following AC with ECoG have been well studied, clinical and ECoG features associated with acute and subacute seizures following surgery using AC with ECoG have not been well established.
Methods:
Following IRB approval, medical records, neuroimaging results, and ECoG data were retrospectively reviewed to assess the incidence and factors associated with acute (within 7 days) and subacute (7-30 days) seizures following AC with ECoG to evaluate incidence of post-operative seizures and corresponding risk factors. All patients were admitted to the neurological ICU after surgery.
Results:
One hundred fifty-five patients (67 females) underwent AC. An average age of 51.2 (range 17-93) and mean duration of hospitalization was 3.3 days (range 1-57) after neurosurgery. 79 (51.0%) had pre-operative epilepsy. One hundred twenty seven (82.0%) underwent surgery for tumor resection (12 metastases, 115 gliomatous). One hundred forty two (91.6%) underwent ECoG, 69 with a novel circular grid and 73 with strip electrodes. All but seven underwent post-operative neuroimaging within 72 hours of surgery. Acute and/or subacute post-operative seizures occurred in 16.1% of the entire cohort, and 17.6% of those undergoing ECoG (25 patients: 16 acute, nine subacute). One patient had status epilepticus. Preoperative epilepsy (p=0.042) and low Karnofsky Performance Score (KPS) (p=0.043), and perioperative SAH (p=0.009) and new or worsened neurological deficit (p=0.013) were related to a higher incidence of acute post-operative seizures. Acute and subacute post-operative seizures were more likely in patients with a history of epilepsy (p=0.022) and perioperative SAH (p=0.029). Post-operative MRI without acute abnormalities was associated with a lower incidence of acute (p=0.009) and both acute and subacute post-operative seizures (p=0.001). Acute post-operative seizures resulted in longer hospitalization (p=0.069) and lower post-operative KPS (p=0.016). Intraoperative seizures, ECoG features, type of lesion resected, extent of resection, tumor characteristics, and the type of ECoG electrode used during AC were not associated with the incidence of post-operative seizures.
Conclusions:
In patients undergoing AC with ECoG, nearly 1/5 may experience acute and/or subacute post-operative seizures. A history of epilepsy, lower preoperative KPS, perioperative SAH, and a new neurological deficit are associated with acute and/or subacute post-operative seizures. Funding: None