Seizure Outcome After Intraoperative Electrocorticography-Tailored Epilepsy Surgery: A Systematic Review and
Jiaojiao Guo1, Ziyi Wang1, Maryse A van 't Klooster1
1From the Department of Neurology and Neurosurgery (J.G., Z.W., M.A.K., S.M.V.D.S., F.S.L., K.P.B., M.Z.), University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Part of ERN EpiCARE; and Stichting Epilepsie Instellingen Nederland (SEIN) (M.Z.), the Netherlands.
Intraoperative electrocorticography (ioECoG)-tailored epilepsy surgery yields a 74% favorable seizure outcome. This method, especially complete resection of epileptiform discharge areas, offers better results than non-tailored surgery, particularly for tumors.
Area of Science:
- Neurosurgery
- Epileptology
- Clinical Neuroscience
Background:
- Intraoperative electrocorticography (ioECoG) is a diagnostic tool for epilepsy surgery, but its application and impact on outcomes remain debated.
- Only a limited number of epilepsy surgery centers utilize ioECoG for tailoring surgical interventions.
Purpose of the Study:
- To systematically assess the existing evidence on the efficacy of ioECoG-tailored epilepsy surgery in improving postsurgical seizure control.
- To compare the outcomes of ioECoG-tailored surgery with conventional, non-tailored approaches.
Main Methods:
- A comprehensive literature search was conducted in PubMed and Embase for studies reporting on at least 10 patients undergoing ioECoG-tailored epilepsy surgery with a minimum 6-month follow-up.
- A random-effects model was employed to calculate the pooled rate of favorable seizure outcome (FSO), defined as Engel class I, ILAE class 1, or seizure-free status.
- Meta-regression and Bayesian network meta-analysis were used to investigate heterogeneity and compare outcomes across different surgical strategies, patient demographics, lesion types, and resection completeness.
Main Results:
- The meta-analysis included 83 studies with 3,631 patients, revealing an overall FSO rate of 74% (95% CI 71-77) for ioECoG-tailored surgery, with significant heterogeneity.
- ioECoG-tailored surgeries demonstrated a significantly higher FSO rate compared to non-ioECoG-tailored surgeries (OR 2.10; p < 0.01), albeit with very low certainty evidence.
- Complete resection of tissue generating interictal epileptiform discharges (IEDs) during ioECoG was a strong predictor of FSO (OR 3.04; p < 0.01), with low certainty evidence.
Conclusions:
- Despite limitations in evidence quality, ioECoG-tailored epilepsy surgery achieves a favorable seizure outcome of 74%.
- Complete resection of IED-generating areas identified by ioECoG significantly improves surgical success rates.
- Tumor pathology is associated with better outcomes compared to malformations of cortical development in the context of epilepsy surgery.
More Related Videos
05:54Stereo-Electro-Encephalo-Graphy SEEG With Robotic Assistance in the Presurgical Evaluation of Medical Refractory Epilepsy: A Technical Note
Published on: June 13, 2016
09:32Network Analysis of Foramen Ovale Electrode Recordings in Drug-resistant Temporal Lobe Epilepsy Patients
Published on: December 18, 2016
