• Marc Zanello, Alexandre Roux, Gilles Zah-Bi, Bénédicte Trancart, Eduardo Parraga, Myriam Edjlali, Arnault Tauziede-Espariat, Xavier Sauvageon, Tarek Sharshar, Catherine Oppenheim, Pascale Varlet, Edouard Dezamis, and Johan Pallud.
• 1Department of Neurosurgery, Sainte-Anne Hospital, Paris.
• J. Neurosurg. 2020 Mar 13; 134 (3): 683692683-692.

ObjectiveFunctional-based resection under awake conditions had been associated with a nonnegligible rate of intraoperative and postoperative epileptic seizures. The authors assessed the incidence of intraoperative and early postoperative epileptic seizures after functional-based resection under awake conditions.MethodsThe authors prospectively assessed intraoperative and postoperative seizures (within 1 month) together with clinical, imaging, surgical, histopathological, and follow-up data for 202 consecutive diffuse glioma adult patients who underwent a functional-based resection under awake conditions.ResultsIntraoperative seizures occurred in 3.5% of patients during cortical stimulation; all resolved without any procedure being discontinued. No predictor of intraoperative seizures was identified. Early postoperative seizures occurred in 7.9% of patients at a mean of 5.1 ± 2.9 days. They increased the duration of hospital stay (p = 0.018), did not impact the 6-month (median 95 vs 100, p = 0.740) or the 2-year (median 100 vs 100, p = 0.243) postoperative Karnofsky Performance Status score and did not impact the 6-month (100% vs 91.4%, p = 0.252) or the 2-year (91.7 vs 89.4%, p = 0.857) postoperative seizure control. The time to treatment of at least 3 months (adjusted OR [aOR] 4.76 [95% CI 1.38-16.36], p = 0.013), frontal lobe involvement (aOR 4.88 [95% CI 1.25-19.03], p = 0.023), current intensity for intraoperative mapping of at least 3 mA (aOR 4.11 [95% CI 1.17-14.49], p = 0.028), and supratotal resection (aOR 6.24 [95% CI 1.43-27.29], p = 0.015) were independently associated with early postoperative seizures.ConclusionsFunctional-based resection under awake conditions can be safely performed with a very low rate of intraoperative and early postoperative seizures and good 6-month and 2-year postoperative seizure outcomes. Intraoperatively, the use of the lowest current threshold producing reproducible responses is mandatory to reduce seizure occurrence intraoperatively and in the early postoperative period.

39 keywords...

hide…