Intraoperative electrocorticography in focal drug-resistant epilepsy: A 10-year retrospective single-center study

Intraoperative electrocorticography (ECoG) represents a crucial tool for improving seizure outcomes during epilepsy surgeries by assisting in localization of the epileptogenic zones. There is a shortage of information in the literature regarding single-center experiences and long-term outcomes after ECoG-guided surgeries. Data are particularly scarce from the Eastern Mediterranean Region. The aim of the present retrospective study was to investigate the effectiveness of ECoG-guided epilepsy surgeries performed in a single center in terms of seizure outcomes. The study included 30 patients with drug-resistant epilepsy who underwent ECoG-guided surgeries between January 2013 and December 2024. Participant details, clinical history and data, surgical interventions, and outcomes were all reviewed retrospectively. The intraoperative findings were assessed and post-resection ECoG was used to define the extent of resections. Of the 30 patients, 19 (63.3%) achieved complete seizure freedom (Engel Class I) post-surgery. ECoG revealed zones of preexisting epileptogenic activity in all patients undergoing the procedure, with 43.3% of patients showing no residual interictal discharges on ECoG after resection. ECoG remains relevant in achieving improved outcomes in epilepsy surgery, with seizure freedom accurately predicted by post-surgical ECoG silence.