Patient Outcomes and Quality of Electrocorticography in Pediatric Epilepsy Surgery: A Case Series

Electrocorticography is a valuable technique for guiding resective epilepsy surgery, yet there is heterogeneous literature regarding its efficacy and the influence of anesthetic agents. We examined the anesthetic and neurological outcomes of patients undergoing electrocorticography-guided procedures to characterize our current practice within the pediatric population.

With ethical approval, we gathered prospective observational data from 24 patients aged 0 to 18-years-old undergoing electrocorticography procedures at British Columbia Children's Hospital. We collected (i) preoperative patient information, (ii) intraoperative anesthetic and neuromonitoring details, (iii) immediate postoperative outcomes, and (iv) Engel Class 1-year postsurgery.

Of 24 patients, 63% were male with a median (range) age of 12 (2 to 18) years. Sevoflurane, dexmedetomidine, and remifentanil were the most common maintenance agents, with sevoflurane minimized during electrocorticography recording. Almost all recordings were subjectively rated by the neurologist/neuromonitoring technicians as "good" or "excellent" quality. One procedure was abandoned as the seizure focus area overlapped the eloquent cortex and would have left the patient with a motor deficit. No anesthetic or electrocorticography-related complications were found. One year postoperatively, 68% of patients had complete seizure freedom (Engel class I), 16% had rare disabling seizures (Engel class II), and 12% had worthwhile improvement (Engel class III).

Our team implemented an anesthetic protocol that supports quality electrocorticography recordings and contributes to good postresection seizure outcomes without complications. Future research may identify and explore modifiable factors to improve outcomes in the subset of patients who did not see worthwhile improvement in seizure control (Engel class IV).