• Ricardo A Domingo, Tito Vivas-Buitrago, Gaetano De Biase, Erik H Middlebrooks, Perry S Bechtle, David S Sabsevitz, Alfredo Quiñones-Hinojosa, and William O Tatum.
• Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida, USA.
• Oper Neurosurg (Hagerstown). 2021 Jul 15; 21 (2): E147-E152.

Background And ImportanceData supporting the use of electrocorticography (ECoG) monitoring during electrical stimulation in awake craniotomies for resection of supratentorial neoplasms is robust, but its applicability during active resection is often limited by the inability to keep the array in place. Given the known survival benefit of gross total resection in glioma surgery, novel approaches to surgical monitoring are warranted to maximize safe resection and optimize surgical outcomes in patients with glioblastoma.Clinical PresentationA 68-yr-old right-handed woman presented to the emergency department with confusion. Imaging studies revealed a bifrontal intra-axial brain lesion. She underwent a left-sided awake craniotomy procedure with cortical and subcortical mapping. During surgical resection, multiple electrographic seizures were detected on continuous ECoG monitoring with a customized 22-channel high-density hollow circular array. She remained without clinical evidence of seizures at 3 mo after surgery.ConclusionWe report a unique case of serial electrographic seizures detected during continuous intraoperative ECoG monitoring during active surgical resection of a glioblastoma using a novel circular hollow array during an awake craniotomy. The use of continuous ECoG monitoring during active resection may provide additional data, with potential influence in outcomes for patients undergoing resection of high-grade glial neoplasms.© Congress of Neurological Surgeons 2021.

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