Neurophysiological support of surgical treatment in structural epilepsy: experience of Polenov neurosurgical institute

Epileptic seizures caused by neoplasms of brain and its meninges play a significant role among other types of structural epilepsy. The algorithms of using different neurophysiological monitoring tools in the patients operated for neoplasms associated with structural epilepsy, are poorly determined so far. The present study is aimed for evaluation of our experience with applications of neurophysiological examination tools in structural epilepsy in the patients with neuro-oncological disorders subjected to surgical treatment at A. L. Polenov Neurosurgical Institute.

PURPOSE: to evaluate experience of neurophysiological support during surgery treatment of structural epilepsy aiming for increased efficiency of surgical treatment of this disorder.

MATERIALS AND METHODS. We have examined 241 patients 18 to 75 years old, subjected to neurosurgical treatment due to malignancies of brain and meninges associated with symptoms of structural epilepsy over 2018–2021.

RESULTS. The study has shown a need for polymodal neurophysiological monitoring in cases of proven epileptogenic foci. Electroencephalography and electrocorticography are used when epileptogenic focus is located beyond functionally significant areas (performed in 38.4 % of intracerebral neoplasias, and in 76.7 % of convexital meningiomas). Meanwhile, motor cortical mapping is required if the focus is located within functionally significant areas (for 61.6 % of the patients with brain neoplasias, and 23.3 %, with convexital meningioma). We have also shown that, in terms of removing epileptogenic focus, intraoperational electrocorticography proved to be as sensitive as 61 %, thus two-fold exceeding diagnostic sensitivity of electroencephalography performed during the surgical invasion.

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