An intraoperative multimodal neurophysiologic approach to successful resection of precentral gyrus epileptogenic lesions

Mirela V. Simon, Andrew J. Cole, Eric C. Chang, Bradley R. Buchbinder, Steve M. Stufflebeam, Ala Nozari, Anat O. Stemmer-Rachamimov, Emad N. Eskandar

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Cortical dysplasias (CDs) are highly epileptogenic lesions with a good prognosis of seizure freedom, if totally resected. However, their accurate delineation and resection can be difficult, and depend on the extent of pathology and lesion location. Intraoperative neurophysiologic assessments are valuable in these situations. We present an illustrative case of intractable epilepsy where judicious use of intraoperative neurophysiologic-techniques guided resection of precentral CD, under general anesthesia and in the absence of preoperative electrophysiologic mapping data. Ictal onset was accurately delineated using electrocorticography (ECoG). Phase reversal of the median somatosensory-evoked potentials (MSSEPs) localized the central sulcus (CS). Motor evoked potentials (MEPs) triggered by high-frequency monopolar anodal electrical cortical stimulation at the primary motor cortex (PMC) threshold delineated the PMC. Using this technique, PMC and the corticospinal tract (CST) were continuously monitored during resection. No changes in MEPs from the preresection baseline were seen; no residual abnormal activity was present in the postresection ECoG. The patient emerged from surgery without deficits and has been seizure free during a 10-month follow-up. Staged multimodal intraoperative neurophysiology can be used successfully under general anesthesia to guide resection of epileptogenic lesions within the precentral gyrus, as an add-on or, in certain situations, as a viable alternative to preoperative electrophysiologic mapping.

Original languageEnglish (US)
JournalEpilepsia
Volume53
Issue number4
DOIs
StatePublished - Apr 1 2012
Externally publishedYes

Fingerprint

Motor Cortex
Frontal Lobe
Malformations of Cortical Development
Motor Evoked Potentials
General Anesthesia
Seizures
Pyramidal Tracts
Neurophysiology
Somatosensory Evoked Potentials
Electric Stimulation
Stroke
Pathology
Electrocorticography

Keywords

  • Central sulcus
  • Cortical dysplasia
  • Electrocorticography
  • Motor mapping

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

Cite this

An intraoperative multimodal neurophysiologic approach to successful resection of precentral gyrus epileptogenic lesions. / Simon, Mirela V.; Cole, Andrew J.; Chang, Eric C.; Buchbinder, Bradley R.; Stufflebeam, Steve M.; Nozari, Ala; Stemmer-Rachamimov, Anat O.; Eskandar, Emad N.

In: Epilepsia, Vol. 53, No. 4, 01.04.2012.

Research output: Contribution to journalArticle

Simon, Mirela V. ; Cole, Andrew J. ; Chang, Eric C. ; Buchbinder, Bradley R. ; Stufflebeam, Steve M. ; Nozari, Ala ; Stemmer-Rachamimov, Anat O. ; Eskandar, Emad N. / An intraoperative multimodal neurophysiologic approach to successful resection of precentral gyrus epileptogenic lesions. In: Epilepsia. 2012 ; Vol. 53, No. 4.
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