The Impact of Intra-operative Electrocorticography in Pediatric Epilepsy Surgery
Abstract number :
2.418
Submission category :
9. Surgery / 9B. Pediatrics
Year :
2021
Submission ID :
1886486
Source :
www.aesnet.org
Presentation date :
12/9/2021 12:00:00 PM
Published date :
Nov 22, 2021, 06:56 AM
Authors :
Tito Onyekweli, BS - University of Pittsburgh School of Medicine; Arka Mallela, MD – Resident, Neurosurgery, University of Pittsburgh Medical Center; Akanksha Chilukuri, BS – Medical Student, University of Pittsburgh School of Medicine; Taylor Abel, MD – Assistant Professor, Neurosurgery, University of Pittsburgh Medical Center
Rationale: Epilepsy surgery is a well-established therapeutic method to treat children with drug-resistant epilepsy. Intraoperative-electrocorticography (ECoG) is used to increase the likelihood of seizure freedom after an initial resection by aiding in the localization of epileptogenic foci. Controversy regarding an additional benefit of intraoperative-ECoG during epilepsy surgery necessitates additional study. We hypothesized that patients with negative intraoperative-ECoG recordings will have improved seizure control compared to patients with resected positive intraoperative-ECoG recordings.
Methods: We analyzed a retrospective cohort of 113 patients who underwent ECoG-guided epilepsy surgery between 2000 and 2020 at UPMC Children’s Hospital of Pittsburgh. Principal outcomes include seizure freedom and acceptable seizure control. Demographic variables, clinical variables including seizure etiology, semiology and frequency; anti-epileptic medication, prior surgical intervention, operative course including application of ECoG, and post-operative course were collected.
Patients were divided into three groups for analysis. Group A, intraoperative-ECoG demonstrated no post-resection abnormalities thus the original surgical plan was not modified. Group B, intraoperative-ECoG demonstrated resectable epileptogenic foci area and modification of the surgical plan was performed. Group C, the original surgical plan was not modified despite the presence of an ECoG abnormality. We performed univariate and multivariate analyses as appropriate.
Results: Study population one-year acceptable seizure control (Engel Class 1 or 2) was 83%. Group A comprised 60%(N=66) of participants; Group B, 27%(N=30); Group C, 13%(N=15). One-year post-surgery seizure control rate in group A was 86%; group B, 80% and group C, 69%. Seizure control rate was not different between the three groups (χ2=1.18, p=0.55). Seizure control rates did not differ between Group A and Group B (p=0.86). Neoplastic pathology was predictive of seizure freedom (OR:3.3,CI:1.5-7.2, p=0.03). Group B did not have different complication rates compared to Group A (χ2=0.1245, OR: 1.217, CI: 0.3930-3.365, p = 0.0.7782).
Conclusions: This series demonstrates negative intraoperative-ECoG recordings were not associated with an increased likelihood of seizure freedom. This suggests that if preoperative workup adequately localizes the epileptogenic zone, then intraoperative ECoG may not be necessary.
Funding: Please list any funding that was received in support of this abstract.: n/a.
Surgery