Evaluation of postoperative sharp waveforms through EEG and magnetoencephalography

EEGs obtained after craniotomy are difficult to read because of a breach rhythm consisting of unfiltered sharply contoured physiologic waveforms that can mimic interictal epileptiform discharges. Magnetoencephalography (MEG) is less affected by the skull breach. The postcraniotomy EEG and MEG scans of 20 patients were reviewed by two experienced electroencephalographers. Larger interrater variability was found for EEG as compared with MEG. Review of patients who had postoperative seizures suggested that EEG was more sensitive but less specific than MEG in detecting interictal epileptiform discharges. Furthermore, several instances of sharp waveforms that were difficult to evaluate on EEG were found to be more easily interpretable on MEG. MEG may also help determine whether asymmetries in physiologic rhythms on EEG result from the skull defect or are pathologic. MEG should be considered as an adjunctive study in patients with a breach rhythm for evaluation of interictal epileptiform discharges and cerebral dysfunction.