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  • Intraoperative Seizures and Cortical Mapping With Awake Craniotomy for Perirolandic Glioma Resections

    Final Number:

    Chikezie Eseonu MD; Jordina Rincon-Torroella MD; Young Min Lee MD, BSPH; karim ReFaey; Alfredo Quinones-Hinojosa MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2016 Annual Meeting

    Introduction: The perirolandic motor area has been reported to have a higher incidence of intraoperative seizures (IOS) during awake craniotomies than any other cortical region. This study evaluates the role of intraoperative seizures on neurological outcome and extent of tumor resection (EOR) in the perirolandic region, as well as analyzes the efficacy of cortical mapping in this region.

    Methods: Thirty-nine patients who underwent an awake craniotomy for a perirolandic glioma by a single-surgeon were retrospectively evaluated for the incidence of IOS and a univariate analysis of preoperative risks, perioperative complications, and EOR between patients with no intraoperative seizure (nIOS) and patients with IOS was conducted. To study neurological outcome in awake craniotomies after perirolandic tumor resection with cortical mapping, a comparative univariate analysis on 28 of the patients who had positive cortical mapping and 11 patients that had negative mapping was conducted.

    Results: We found an incidence of IOS at 12.8% during cortical mapping for awake craniotomies in the perirolandic area, none of which caused an aborted case. Intraoperative seizure patients had a significantly smaller EOR (59.1%) compared to nIOS patients (87.9%) (p=0.043). The length of hospitalization in the IOS patients was also longer (12.4 ± 2.0 days) compared to the nIOS patients (3.7 ± 0.4 days) (p=0.011). Positive cortical mapping had more postoperative seizures (35.7%) compared to negative mapping (0%) (p=0.022). New postoperative motor deficits were also more common in positive mapping patients (60.7%) versus negative mapping patients (18.2%) (p=0.017).

    Conclusions: Intraoperative seizures in awake craniotomies for perirolandic gliomas can limit the extent of tumor resection and cause significant increases in the length of hospitalizations. Craniotomies that limit cortical exposure for perirolandic gliomas in conjunction with negative mapping of eloquent motor regions, allow for aggressive tumor resection with low postoperative motor deficits and seizures.

    Patient Care: This study evaluates intraoperative seizures during awake craniotomies and identifies surgical technique and brain mapping methods that can help reduce the amount of intraoperative seizures patients' experience during awake craniotomies for perirolandic gliomas.

    Learning Objectives: 1) To identify the risks and complications associated with awake cranitiomies for perirolandic region lesions 2) To understand the role of cortical mapping with neurological outcome in perirolandic gliomas 3) To understand the effects of intraoperative seizures and cortical mapping on extent of resection

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