Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Oct 25;12(11):1434.
doi: 10.3390/brainsci12111434.

The Role of Extra-Operative Cortical Stimulation and Mapping in the Surgical Management of Intracranial Gliomas

Kostas N Fountas  1 , Alexandros Brotis  2 , Thanasis Paschalis  2 , Eftychia Kapsalaki  3   4
Affiliations

The Role of Extra-Operative Cortical Stimulation and Mapping in the Surgical Management of Intracranial Gliomas

Kostas N Fountas et al. Brain Sci. .

Abstract

Background: Aggressive resection without compromising the patient's neurological status remains a significant challenge in treating intracranial gliomas. Our current study aims to evaluate the efficacy and safety of extra-operative stimulation and mapping via implanted subdural electrodes with or without depth (EOCSM), offering an alternative approach when awake mapping is contraindicated.

Methods: Fifty-one patients undergoing EOCSM for glioma resection in our institution formed the sample study of our current retrospective study. We assessed the effectiveness and safety of our approach by measuring the extent of resection and recording the periprocedural complications, respectively.

Results: The mean age of our participants was 58 years (±9.4 years). The lesion was usually located on the left side (80.4%) and affected the frontal lobe (51.0%). EOCSM was successful in 94.1% of patients. The stimulation and electrode implantation procedures lasted for a median of 2.0 h and 75 h, respectively. Stimulation-induced seizures and CSF leakage occurred in 13.7% and 5.9% of our cases. The mean extent of resection was 91.6%, whereas transient dysphasia occurred in 21.6% and transient hemiparesis in 5.9% of our patients, respectively.

Conclusions: Extraoperative stimulation and mapping constitute a valid alternative mapping option in glioma patients who cannot undergo an awake craniotomy.

Keywords: electrode; extra-operative; glioma; mapping; stimulation; subdural.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
(a–c) Intraoperative photos (during the implantation procedure) demonstrate various combinations of strip and grid subdural electrodes for extra-operative stimulation and mapping. Adequate cortical exposure is required for safer electrode implantation.
Figure 2
Figure 2
(a,b) Postimplantation CT scan (coronal view) and 3D model are used for verifying the location of the implanted electrodes and their contacts.
Figure 3
Figure 3
(a,b) Intra-operative photos (during the electrode removal and the tumour resection procedure) depict small-size epidural hematomas, which required no surgical evacuation and had no clinical significance.
Figure 4
Figure 4
The extent of resection was influenced by the anatomic location of the glioma.
Figure 5
Figure 5
The intra-operative blood loss was positively affected by the histological grade of the glioma and the extent of resection.
See this image and copyright information in PMC

References

    1. Hervey-Jumper S.L., Berger M.S. Role of surgical resection in low- and high-grade gliomas. Curr. Treat. Options Neurol. 2014;16 doi: 10.1007/s11940-014-0284-7. - DOI - PubMed
    1. Smith J.S., Chang E.F., Lamborn K.R., Chang S.M., Prados M.D., Cha S., Tihan T., Vandenberg S., McDermott M.W., Berger M.S. Role of extent of resection in the long-term outcome of low-grade hemispheric gliomas. J. Clin. Oncol. Off. J. Am. Soc. Clin. Oncol. 2008;26:1338–1345. doi: 10.1200/JCO.2007.13.9337. - DOI - PubMed
    1. Hervey-Jumper S.L., Berger M.S. Maximizing safe resection of low- and high-grade glioma. J. Neurooncol. 2016;130:269–282. doi: 10.1007/s11060-016-2110-4. - DOI - PubMed
    1. D’Amico R.S., Englander Z.K., Canoll P., Bruce J.N. Extent of Resection in Glioma–A Review of the Cutting Edge. World Neurosurg. 2017;103:538–549. doi: 10.1016/j.wneu.2017.04.041. - DOI - PubMed
    1. Wolf J., Campos B., Bruckner T., Vogt L., Unterberg A., Ahmadi R. Evaluation of neuropsychological outcome and “quality of life” after glioma surgery. Langenbeck’s Arch. Surg. 2016;401:541–549. doi: 10.1007/s00423-016-1403-6. - DOI - PubMed

LinkOut - more resources