Brain tumors in eloquent areas: A European multicenter survey of intraoperative mapping techniques, intraoperative seizures occurrence, and antiepileptic drug prophylaxis

Brain tumors in eloquent areas: A European multicenter survey of intraoperative mapping techniques, intraoperative seizures occurrence, and antiepileptic drug prophylaxis

Original Article

DOI: 10.1007/s10143-016-0771-2

Cite this article as:
Spena, G., Schucht, P., Seidel, K. et al. Neurosurg Rev (2016). doi:10.1007/s10143-016-0771-2

Abstract

Intraoperative mapping and monitoring techniques for eloquent area tumors are routinely used world wide. Very few data are available regarding mapping and monitoring methods and preferences, intraoperative seizures occurrence and perioperative antiepileptic drug management. A questionnaire was sent to 20 European centers with experience in intraoperative mapping or neurophysiological monitoring for the treatment of eloquent area tumors. Fifteen centers returned the completed questionnaires. Data was available on 2098 patients. 863 patients (41.1%) were operated on through awake surgery and intraoperative mapping, while 1235 patients (58.8%) received asleep surgery and intraoperative electrophysiological monitoring or mapping. There was great heterogeneity between centers with some totally AW oriented (up to 100%) and other almost totally ASL oriented (up to 92%) (31% SD). For awake surgery, 79.9% centers preferred an asleep-awake-asleep anesthesia protocol. Only 53.3% of the centers used ECoG or transcutaneous EEG. The incidence of intraoperative seizures varied significantly between centers, ranging from 2.5% to 54% (p < 0.001). It there appears to be a statistically significant link between the mastery of mapping technique and the risk of intraoperative seizures. Moreover, history of preoperative seizures can significantly increase the risk of intraoperative seizures (p < 0.001). Intraoperative seizures occurrence was similar in patients with or without perioperative drugs (12% vs. 12%, p = 0.2). This is the first European survey to assess intraoperative functional mapping and monitoring protocols and the management of peri- and intraoperative seizures. This data can help identify specific aspects that need to be investigated in prospective and controlled studies.

Keywords

Brain mappingBrain neoplasmsEpilepsyNeurophysiological monitoringNeurosurgeons

Abbreviations

AAA

awake-awake-awake anesthesia protocol

AED

antiepileptic drug

SAS

asleep-awake-asleep anesthesia protocol

ASL

asleep surgery

AW

awake surgery

ECoG

electrocorticography

EEG

electroencephalography

MEP

motor evoked potential

IS

intraoperative seizure

SD

standard deviation

IQR

interquartile range

READ MORE: http://link.springer.com/article/10.1007/s10143-016-0771-2 



Categories: Brain Tumor

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