• World Neurosurg · Jul 2021

    Intraoperative cortico-cortical evoked potentials for language monitoring in epilepsy surgery.

    • Valeria Mariani, Ivana Sartori, Martina Revay, Roberto Mai, Domenico Lizio, Luca Berta, Michele Rizzi, and Massimo Cossu.
    • "C. Munari" Centre for Epilepsy Surgery, Grande Ospedale Metropolitano Niguarda, Milan, Italy; Neurology and Stroke Unit, ASST Sette Laghi-Ospedale di Circolo, Varese, Italy.
    • World Neurosurg. 2021 Jul 1; 151: e109-e121.

    ObjectiveTo evaluate the applicability of corticocortical evoked potentials (CCEP) for intraoperative monitoring of the language network in epilepsy surgery under general anesthesia. To investigate the clinical relevance on language functions of intraoperative changes of CCEP recorded under these conditions.MethodsCCEP monitoring was performed in 14 epileptic patients (6 females, 4 children) during resections in the left perisylvian region under general anesthesia. Electrode strips were placed on the anterior language area (AL) and posterior language area (PL), identified by structural and functional magnetic resonance imaging. Single-pulse electric stimulations were delivered to pairs of adjacent contacts in a bipolar fashion. During resection, we monitored the integrity of the dorsal language pathway by stimulating either AL by recording CCEP from PL or vice versa, depending on stability and reproducibility of CCEP. We evaluated the first negative (N1) component of CCEP before, during, and after resection.ResultsAll procedures were successfully completed without adverse events. The best response was obtained from AL during stimulation of PL in 8 patients and from PL during stimulation of AL in 6 patients. None of 12 patients with a postresection N1 amplitude decrease of 0%-15% from baseline presented postoperative language impairment. Decreases of 28% and 24%, respectively, of the N1 amplitude were observed in 2 patients who developed transient postoperative speech disturbances.ConclusionsThe application of CCEP monitoring is possible and safe in epilepsy surgery under general anesthesia. Putative AL and PL can be identified using noninvasive presurgical neuroimaging. Decrease of N1 amplitude >15% from baseline may predict postoperative language deficits.Copyright © 2021 Elsevier Inc. All rights reserved.

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