Focal Cortical Surface Cooling is a Novel and Safe Method for Intraoperative Functional Brain Mapping

Area of Science:

• Neurosurgery
• Neurology
• Medical Devices

Background:

• Electric cortical stimulation (ECS) is the standard for intraoperative functional mapping but carries seizure risks.
• Focal cortical cooling (CC) is explored as a potentially safer alternative for neurosurgical mapping.
• Assessing CC safety is crucial for its adoption in clinical practice.

Purpose of the Study:

• To evaluate the safety and efficacy of focal cortical cooling (CC) as an alternative to electric cortical stimulation (ECS) for intraoperative functional mapping.
• To compare seizure incidence, neurological deficits, and radiographic findings between CC and ECS groups.
• To assess long-term seizure outcomes in patients undergoing CC.

Main Methods:

• Retrospective review of 40 patients undergoing intraoperative CC (CC group) and 55 patients undergoing ECS (ECS-alone group).
• A control group of 25 patients undergoing anterior temporal lobectomy (ATL) without CC or ECS was also included.
• Data collected included intraoperative and postoperative seizure incidence, neurological deficits, radiographic changes, and long-term seizure outcomes (Engel scale).

Main Results:

• Intraoperative seizure incidence was 0% in the CC group versus 3.6% in the ECS-alone group.
• Postoperative seizure incidence within the first week did not significantly differ across CC (7.9%), ECS-alone (9.0%), and no ECS/no CC-ATL (12%) groups.
• No significant differences were observed in postoperative radiographic changes or long-term seizure outcomes (Engel I+II) between the CC and ECS-alone groups.

Conclusions:

• Focal cortical cooling (CC) is a safe technique for intraoperative functional mapping in neurosurgery.
• CC demonstrates comparable safety and efficacy to electric cortical stimulation (ECS).
• CC may serve as a valuable complementary tool to ECS in neurosurgical procedures.