Intraoperative electrocorticography and cortical stimulation in children

Area of Science:

• Pediatric Neurosurgery
• Epileptology
• Neurophysiology

Background:

• Medically refractory epilepsy in children poses significant management challenges.
• Intraoperative electrocorticography (ECoG) and cortical stimulation are utilized to guide epilepsy surgery.
• Evidence for their utility in pediatric populations is limited and somewhat controversial.

Purpose of the Study:

• To review the utility of intraoperative electrocorticography and cortical stimulation in pediatric epilepsy surgery.
• To highlight specific circumstances where these techniques are valuable.
• To discuss differences in cortical stimulation parameters and responses in children compared to adults.

Main Methods:

• Review of existing literature on electrocorticography and cortical stimulation in pediatric epilepsy surgery.
• Analysis of specific applications including localization, extent of resection, functional mapping, and outcome prediction.
• Comparison of pediatric and adult responses to cortical stimulation.

Main Results:

• Electrocorticography is valuable for tailoring resections in temporal lobectomies and guiding surgery for brain malformations, tumors, and neocortical lesions, particularly near eloquent cortex.
• Cortical stimulation is a safe and reliable technique for assessing motor, sensory, and speech function in children, though requiring higher amperage thresholds and showing variability.
• Cortical stimulation can identify functional reorganization in pediatric cases due to congenital lesions and cerebral plasticity, with results consistent with fMRI and Wada testing.

Conclusions:

• Electrocorticography and cortical stimulation are useful, albeit invasive, tools in pediatric epilepsy surgery, offering high accuracy for tailored resections.
• Cortical stimulation is indicated when resection involves or is near eloquent cortex.
• Despite level IV evidence, these techniques remain essential due to practical and ethical limitations of randomized trials in pediatric populations.