Beyin tümörlerinin cerrahi eksizyonu sırasında elektrokortikografinin kullanımı

Amaç: Beyin tümörlü hastalarda elektroensefalografi (EEG) ve elektrokortikografinin (ECoG), preoperatif nöbetlerin insidansı ile ilişkisini araştırmayı amaçladık. Yöntem: Bu çalışmamızda glial tümör görünümü olan 11 olguda operasyon öncesi ve sonrası EEG ve operasyon esnasında eksizyon öncesi ve sonrası kraniotomi alanından ECoG kayıtları alındı. Bulgular: Operasyon öncesi epileptik nöbet anamnezi olmayanların aksine epileptik nöbet anamnezi olan hastaların % 80'inin pre- ve postoperatif EEG'lerinde epileptik aktivite (EA) mevcuttu ve ECoG'lerinde de sadece tümöre yakın değil, uzak alanlarda da EA vardı. Sonuç: Bulgularımız daha önceki yayınların aksine tümörün çıkarılmasının EEG ve ECoG'deki EA'yi ortadan kaldırmadığını ve epileptik atak öyküsü olan hastaların EEG ve EcoG'lerinin epileptik nöbet hikayesi olmayanlardan farklı olduğunu göstermiştir.

The use of electrocorticography during the excision of brain tumors

Objective: In this study we aimed to investigate the relationship of electrocorticography (ECoG) and electroencephalography (EEG) with the incidence of preoperative seizures in patients with brain tumors. Methods: Eleven patients with glial tumor appearances were investigated. During the operation pre- and postexcisional ECoG recordings were obtained from the craniotomy area beside pre- and postoperative EEG. Results: 80% of the patients who had a seizure anamnesis had epileptic' activity (EA) in their pre- and postoperative EEG recordings and also had EA in near and far areas to the tumor site in their ECoG recordings in contrast to the patients who had no seizure anamnesis. Conclusion: In contrast to previous studies, our results have demonstrated that the excision of the tumor did not eliminate the EA in EEG and ECoG. The EEG and ECoG recordings showed their own characteristics in patients with a seizure anamnesis.

___

  • 1. Neto AR, Ferraz FP, Campos CR, Braga FM. Patients with epileptic seizures and cerebral lesions who underwent lesionectomy restricted to or associated with the adjacent irritative area. Epilepsia 1999;40:856-64.
  • 2. Wennberg R, Quesney LF, Lozano A, Olivier A, Rasmussen T. Role of electrocorticography at surgery for lesion-related frontal lobe epilepsy. Can J Neurol Sci 1999;26:33-9.
  • 3. Tran TA, Spencer SS, Javidan M, Pacia S, Marks D, Spencer DD. Significance of spikes recorded on intraoperative electrocorticography in patients with brain tumor and epilepsy. Epilepsia 1997;38:1132-9.
  • 4. Im SH, Chung CK, Cho BK, Lee SK. Supratentorial ganglioglioma and epilepsy: Postoperative seizure outcome. J Neurooncol 2002;57:59-66.
  • 5. Hwang SL, Lieu AS, Kuo TH, Lin CL, Chang CZ, Huang TY, et al. Preoperative and postoperative seizures in patients with astrocytic tumours: Analysis of incidence and influencing factors. J Clin Neurosci 2001;8:426-9.
  • 6. Kim SK, Wang KC, Hwang YS, Kim KJ, Cho BK. Intractable epilepsy associated with brain tumors in children: Surgical modality and outcome. Childs Nerv Syst 2001;17:445-52.
  • 7. Ildan F, Tuna M, Göçer IA, Erman T, Cetinalp E. Intracerebral ganglioglioma: Clinical and radiological study of eleven surgically treated cases with follow-up. Neurosurg Rev 2001;24:114-8
  • 8. Telfeian AE, Philips MF, Crino PB, Judy KD. Postoperative epilepsy in patients undergoing craniotomy for glioblastoma multiforme. J Exp Clin Cancer Res 2001;20:5-10.
  • 9. Franceschetti S, Binelli S, Casazza M, Lodrini S, Panzica F, Pluchino F, et al. Influence of surgery and antiepileptic drugs on seizures symptomatic of cerebral tumors. Acta Neurochir (Wien) 1990;103:47-51.
  • 10. Penfield W, Erickson TC, Tarlov IM. Relation of intracranial tumors and symptomatic epilepsy. Arch Neurol Psychiatry 1940;44:300-15.
  • 11. Rasmussen TB. Surgery of epilepsy associated with brain tumors. Adv Neurol 1975;8:227-39.
  • 12. Haglund MM, Berger MS, Kunkel DD, Franck JE, Ghatan S, Ojemann GA. Changes in GABA and somatostatin in epileptic cortex associated with low-grade gliomas. J Neurosurg 1992;77:209-16.
  • 13. Berger MS, Kincaid J, Ojemann GA, Lettich E. Brain mapping techniques to maximize resection, safety, and seizure control in children with brain tumors. Neurosurg 1989;25:786-92.
  • 14. Berger MS, Ghatan S, Geyer JR, Keles GE, Ojemann GA. Seizure outcome in children with hemispheric tumors and associated intractable epilepsy: The role of tumor removal combined with seizure foci resection. Pediatr Neurosurg 1991-1992;17:185-91.
  • 15. Pilcher WH, Silbergeld DL, Berger MS, Ojemann GA. Intraoperative electrocorticography during tumor resection: Impact on seizure outcome in patients with gangliogliomas. J Neurosurg 1993;78:891-902.
  • 16. Berger MS, Ghatan S, Haglunt MM, Dobins J, Ojemann GA. Low- grade gliomas associated with intractable epilepsy: Seizure outcome utilizing electrocorticography during tumor resection. J Neurosurg 1993;79:62-9.
  • 17. Jooma R, Yeh HS, Privitera MD, Gartner M. Lesionectomy versus electrophysiologically guided resection for temporal lobe tumors manifesting with complex partial seizures. J Neurosurg 1995;83:231-6.
  • 18. Cascino GD. Epilepsy and brain tumors: Implications for treatment. Epilepsia 1990;31:37-44.
  • 19. Cascino GD, Kelly PJ, Hirschhorn KA, Marsh WR, Sharbrough FW. Stereotactic resection of intra-axial cerebral lesions in partial epilepsy. Mayo Clin Proc 1990;65:1053-60.
  • 20. Goldring S, Rich KM, Picker S. Experience with gliomas in patients presenting with a chronic seizure disorder. In: Little JR, editor. Clinical Neurosurgery. New York: Raven Press; 1986; p.15-42.
  • 21. Hirsch JR, Rose CS, Pierre-Khan A, Pfister A, Hoppe-Hirsch E. Benign astrocytic and oligodendrocytic tumors of the cerebral hemispheres in children. J Neurosurg 1989;70:568-72.
  • 22. Taylor DC. One hundred years of epilepsy surgery: Sir Victor Horsley’s contribution. In: Engle JJr, editor. Surgical treatment of epilepsies. New York: Raven Press; 1987: p.22-37.
  • 23. Foerster O, Penfield W. The structural basis of traumatic epilepsy and results of radical operation. Brain 1930;53:8-119.
  • 24. Falconer MA, Cavanagh JB. Clinicopathological considerations of temporal lobe epilepsy due to small focal lesions:a study of cases submitted to operation. Brain 1959;82:484-504.
  • 25. Yeh HS, Tew JM, Jgartner M. Seizure control after surgery on cerebral arteriovenous malformations. J Neurosurg 1993;78:12-8.
  • 26. Goldring S. Pediatric epilepsy surgery. Epilepsia 1987;28:82-102.
  • 27. Spencer DD, Spencer SS, Mattson RH, Williamson PD. Intracerebral masses in patients with intractable partial epilepsy. Neurology 1984;34:432-6.