Intraoperative Electrocorticographic Monitoring for Predicting Post-Traumatic Seizures and Prognosticating Patients
Shashikant Verma1, Namrata Khandelwal2, Jitin Bajaj1
1Department of Neurosurgery, Superspeciality Hospital, NSCB Medical College, Jabalpur , Madhya Pradesh , India.
Operative Neurosurgery (Hagerstown, Md.)
|September 23, 2025
Summary
Intraoperative electrocorticography (ECoG) abnormalities in traumatic brain injury (TBI) patients predict higher seizure risk and worse outcomes. Abnormal ECoG findings indicate increased mortality and poorer functional recovery, suggesting its use as a prognostic tool.
Area of Science:
- Neurosurgery
- Epileptology
- Neurocritical Care
Background:
- Post-traumatic epilepsy (PTE) is a significant complication of traumatic brain injury (TBI).
- Predictive tools and preventive strategies for PTE remain limited.
- Intraoperative electrocorticography (ECoG) is underutilized in TBI management despite its use in other neurosurgical procedures.
Purpose of the Study:
- To evaluate the predictive value of intraoperative ECoG for seizure development in TBI patients.
- To assess the correlation between intraoperative ECoG findings and functional outcomes post-TBI.
- To explore the prognostic utility of ECoG in TBI management.
Main Methods:
- A prospective observational study involving 110 patients with head injury undergoing surgery and intraoperative ECoG.
- ECoG recordings were classified as normal or abnormal based on epileptiform activity.
- Patients were followed for 12 months, assessing seizure incidence, mortality, and functional outcomes (mRS, GOS).
Main Results:
- Abnormal intraoperative ECoG findings were observed in 54.5% of patients.
- Patients with abnormal ECoG showed significantly higher seizure incidence at 30 days and 6 months (P < .001).
- Burst suppression patterns on ECoG were associated with 100% mortality, and abnormal ECoG correlated with worse functional outcomes (P < .001).
Conclusions:
- Intraoperative ECoG abnormalities are strong predictors of increased seizure risk, mortality, and poor functional outcomes in TBI patients.
- Intraoperative ECoG can serve as a valuable prognostic tool in neurosurgical practice.
- ECoG findings may guide decisions regarding antiseizure medication and rehabilitation strategies.
