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Bipolar Electrocoagulation on Cortex after AVMs Lesionectomy for Seizure Control

Published online by Cambridge University Press:  23 July 2018

Yong Cao ,
Rong Wang ,
Lijun Yang ,
Qin Bai ,
Shuo Wang  and
Jizong Zhao
Yong Cao*
Affiliation:
Division of Neurosurgery, Beijing Tiantan Hospital, affiliated to Capital Medical University
Rong Wang
Affiliation:
Division of Neurosurgery, Beijing Tiantan Hospital, affiliated to Capital Medical University
Lijun Yang
Affiliation:
Division of Neurosurgery, Beijing Tiantan Hospital, affiliated to Capital Medical University
Qin Bai
Affiliation:
Department of Electroneurophysiology, Beijing Neurosurgical Institution, Chongwen District, Beijing, China
Shuo Wang
Affiliation:
Division of Neurosurgery, Beijing Tiantan Hospital, affiliated to Capital Medical University
Jizong Zhao*
Affiliation:
Division of Neurosurgery, Beijing Tiantan Hospital, affiliated to Capital Medical University
*
Department of Neurosurgery, Beijing Tiantan Hospital, affiliated to Capital Medical University, 6 Tiantan Xili, Beijing 100050, China
Department of Neurosurgery, Beijing Tiantan Hospital, affiliated to Capital Medical University, 6 Tiantan Xili, Beijing 100050, China
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Abstract:

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Background:

The findings of previous studies remain controversial on the optimal management required for effective seizure control after surgical excision of arteriovenous malformations (AVMs). We evaluated the efficacy of additional bipolar electrocoagulation on the electrically positive cortex guided by intraoperative electrocorticography (ECoG) for controlling cerebral AVMs-related epilepsy.

Clinical Material and Methods:

Sixty consecutive patients with seizure due to cerebral AVMs, who underwent surgical excision of cerebral AVMs and intraoperative ECoG, were assessed. The AVMs and surrounding hemosiderin stained tissue were completely removed, and bipolar electrocoagulation was applied on the surrounding cerebral cortex where epileptic discharges were monitored via intraoperative ECoG. Patients were followed up at three to six months after the surgery and then annually. We evaluated seizure outcome by using Engel's classification and postoperative complications.

Results:

Forty-nine patients (81.6%) were detected of epileptic discharges before and after AVMs excision. These patients underwent the removal of AVMs plus bipolar electrocoagulation on spike-positive site cortex. After electrocoagulation, 45 patients' epileptic discharges disappeared, while four obviously diminished. Fifty-five of 60 patients (91.7%) had follow-up lasting at least 22 months (mean 51.1 months; range 22-93 months). Determined by the Engel Seizure Outcome Scale, 39 patients (70.9%) were Class I, seven (12.7%) Class II, five (9.0%) Class III, and four (7.2%) Class IV.

Conclusions:

Even alter the complete removal of AVM and sunwinding gliolic and hemosiderin stained tissue, a high-frequency residual spike remained on the surrounding cerebral cortex. Effective surgical seizure control can be achieved by carrying on I additional bipolar electrocoagulation on the cortex guided by the intraoperative ECoG.

Résumé:

Résumé:Contexte:

Les observations faites lors d'etudes anterieures sur le traitement optimal requis pour obtenir un controle efficace des crises convulsives apres resection chirurgicale de malformations arterioveneuses (MAV) demeurent un sujet de controverse. Nous avons evalue l'efficacite de 1'ajout de l'electrocoagulation bipolaire sur le cortex electriquement positif, guide par electrocorticographie (ECoG) pour le controle de I'epilepsie reliee aux MAV cerebrales.

Méthodes:

Soixante patients consecutifs atteints de crises convulsives dues a des MAV cerebrales, qui ont subi une excision chirurgicale d'une MAV cerebrale avec ECoG pendant 1'intervention, ont ete evalues. Les MAV et le tissu avoisinant teinte d'hemosiderine ont ete completement excises et une electrocoagulation bipolaire a ete appliquee sur le cortex cerebral avoisinant ou des decharges epileptiques etaient observees par ECoG pendant l'intervention. Les patients ont ete revus entre trois et six mois apres la chirurgie et annuellement par la suite. Nous avons evalue le resultat obtenu au moyen de la classification des crises convulsives de Engel ainsi que les complications pomopcYakiires.,

Résultats:

Des decharges epileptiques ont ete detectees avant et apres l'excision de la MAV chez 49 patients (81,6%). Ces patients out subi une excision de I'AMV et une electrocoagulation bipolaire du cortex ou des pointes etaient detectees. Apres l'electrocoagulation, les decharges epileptiques ont disparu chez 45 patients et ont diminue de facon evidente chez 4. Cinquante-cinq des 60 patients (91,7%) ont ete suivis pendant au moins 22 mois (moyenne 51,1 mois ; ecart de 22 a 93 mois). Selon la Engel Seizure Outcome Scale, 39 patients (70,9%) ont ete assignes a la classe I, 7 (12,7%) a la classe II, 5 (9,0%) a la classe III et 4 (7,2%) a la classe IV.

Conclusions:

Une pointe residuelle a haute frequence etait presente sur le cortex cerebral avoisinant, meme apres l'excision complete de la MAV, du tissu glial et du tissu avoisinant teinte d'hemosiderine. Un controle chirurgical efficace des crises peut etre obtenu en effectuant une electrocoagulation bipolaire guidee par 1'ECoG sur le cortex pendant 1'intervention.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 38 , Issue 1 , January 2011 , pp. 48 - 53
Copyright
Copyright © Canadian Neurological Sciences Federation 2011

Footnotes

*

These authors contributed equally to this work.

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