Abstract
Background: The use of electrocorticography (ECoG) to avoid intraoperative stimulation-induced seizure (ISS) during awake craniotomy is controversial. Although a standard direct cortical stimulating (DCS) protocol is used to identify the eloquent cortices and subcortical structures, ISS still occurs. Epilepsy is related to alterations in brain networks. In this study, we investigated specific alterations in brain networks in patients with ISS.Methods: Twenty-seven patients with glioma were enrolled and categorized into the ISS and non-ISS groups based on their history of ISS occurrence. A standard DCS protocol was used during awake craniotomy without ECoG supervision. Graph theoretical measurement was used to analyze resting-state functional magnetic resonance imaging data to quantitatively reveal alterations in the functional networks.Results: In the sensorimotor networks, the glioma significantly decreased the functional connectivity (FC) of four edges in the ISS group, which were conversely increased in the non-ISS group after multiple corrections (p < 0.001, threshold of p-value = 0.002). Regarding the topological properties, the sensorimotor network of all participants was classified as a small-world network. Glioma significantly increased global efficiency, nodal efficiency, and the sigma value, as well as decreased the shortest path length in the ISS group compared with the non-ISS group (p < 0.05).Conclusions: The specific alterations indicating patient susceptibility to ISS during DCS increased global and nodal efficiencies and decreased the shortest path length and FC induced by gliomas. If the patient has these specific alterations, ECoG is recommended to monitor after-discharge current during DCS to avoid ISS.
Highlights
Awake craniotomy (AC) is the optimal approach to prevent neurological deficits when eloquent structures are invaded [1]
We retrospectively reviewed 84 patients diagnosed with gliomas who underwent AC with direct cortical stimulation (DCS) to preserve motor, sensory, and motor-related language functions between March 2017 and March 2019 at Beijing Tiantan hospital
This study investigated the alterations of functional connectivity (FC) and topological properties in the sensorimotor networks of patients with and without ISS during DCS
Summary
Awake craniotomy (AC) is the optimal approach to prevent neurological deficits when eloquent structures are invaded [1]. Intraoperative stimulation-induced seizure (ISS) is the most serious complication of AC. Boetto et al [16] suggested that ECoG was unnecessary for AC They proposed that ISS incidence was only 3.5% and that using ECoG would only complicate the surgical process. The use of electrocorticography (ECoG) to avoid intraoperative stimulation-induced seizure (ISS) during awake craniotomy is controversial. A standard direct cortical stimulating (DCS) protocol is used to identify the eloquent cortices and subcortical structures, ISS still occurs. We investigated specific alterations in brain networks in patients with ISS
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