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Alsallom F, Simon MV. Pediatric Intraoperative Neurophysiologic Mapping and Monitoring in Brain Surgery. J Clin Neurophysiol 2024; 41:96-107. [PMID: 38306217 DOI: 10.1097/wnp.0000000000001054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2024] Open
Abstract
SUMMARY Similar to adults, children undergoing brain surgery can significantly benefit from intraoperative neurophysiologic mapping and monitoring. Although young brains present the advantage of increased plasticity, during procedures in close proximity to eloquent regions, the risk of irreversible neurological compromise remains and can be lowered further by these techniques. More so, pathologies specific to the pediatric population, such as neurodevelopmental lesions, often result in medically refractory epilepsy. Thus, their successful surgical treatment also relies on accurate demarcation and resection of the epileptogenic zone, processes in which intraoperative electrocorticography is often employed. However, stemming from the development and maturation of the central and peripheral nervous systems as the child grows, intraoperative neurophysiologic testing in this population poses methodologic and interpretative challenges even to experienced clinical neurophysiologists. For example, it is difficult to perform awake craniotomies and language testing in the majority of pediatric patients. In addition, children may be more prone to intraoperative seizures and exhibit afterdischarges more frequently during functional mapping using electrical cortical stimulation because of high stimulation thresholds needed to depolarize immature cortex. Moreover, choice of anesthetic regimen and doses may be different in pediatric patients, as is the effect of these drugs on immature brain; these factors add additional complexity in terms of interpretation and analysis of neurophysiologic recordings. Below, we are describing the modalities commonly used during intraoperative neurophysiologic testing in pediatric brain surgery, with emphasis on age-specific clinical indications, methodology, and challenges.
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Affiliation(s)
- Faisal Alsallom
- King Fahad Medical City, KFMC Neurosciences Center, Riyadh, Saudi Arabia; and
| | - Mirela V Simon
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, U.S.A
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Sakathevan J, Somasundaram K, Chinyere SC, Rodríguez-Viña C, Martín-López D. Lateralized Periodic Discharges During Remifentanil Infusion. Clin EEG Neurosci 2022; 53:143-147. [PMID: 33900123 DOI: 10.1177/15500594211010624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Lateralized periodic discharges (LPDs) are a common electroencephalographic (EEG) pattern in the neurointensive care unit setting. LPDs are typically observed in association with acute structural lesions of the brain with different etiologies. There are no reports describing a link between the occurrence of LPDs and the administration of remifentanil. Remifentanil is a rapid-acting pure μ-opioid receptor agonist, which is indicated to provide analgesia and sedation in mechanically ventilated patients in intensive care units. We present a case of an 84-year-old man with neuroglycopenia who developed LPDs while sedated with remifentanil. We report, for the first time, a potential relationship between remifentanil and the induction of LPDs.
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Affiliation(s)
| | | | | | - Cristina Rodríguez-Viña
- 1333Ashford and St Peter's Hospital NHS FT, Chertsey, UK.,4968St George's University Hospitals NHS FT, Chertsey, UK
| | - David Martín-López
- 1333Ashford and St Peter's Hospital NHS FT, Chertsey, UK.,4968St George's University Hospitals NHS FT, Chertsey, UK.,4262Kingston Hospital NHS FT, Chertsey, UK
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Wada K, Sonoda M, Firestone E, Sakakura K, Kuroda N, Takayama Y, Iijima K, Iwasaki M, Mihara T, Goto T, Asano E, Miyazaki T. Sevoflurane-based enhancement of phase-amplitude coupling and localization of the epileptogenic zone. Clin Neurophysiol 2022; 134:1-8. [PMID: 34922194 PMCID: PMC8766927 DOI: 10.1016/j.clinph.2021.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 10/05/2021] [Accepted: 11/03/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Phase-amplitude coupling between high-frequency (≥150 Hz) and delta (3-4 Hz) oscillations - modulation index (MI) - is a promising, objective biomarker of epileptogenicity. We determined whether sevoflurane anesthesia preferentially enhances this metric within the epileptogenic zone. METHODS This is an observational study of intraoperative electrocorticography data from 621 electrodes chronically implanted into eight patients with drug-resistant, focal epilepsy. All patients were anesthetized with sevoflurane during resective surgery, which subsequently resulted in seizure control. We classified 'removed' and 'retained' brain sites as epileptogenic and non-epileptogenic, respectively. Mixed model analysis determined which anesthetic stage optimized MI-based classification of epileptogenic sites. RESULTS MI increased as a function of anesthetic stage, ranging from baseline (i.e., oxygen alone) to 2.0 minimum alveolar concentration (MAC) of sevoflurane, preferentially at sites showing higher initial MI values. This phenomenon was accentuated just prior to sevoflurane reaching 2.0 MAC, at which time, the odds of a site being classified as epileptogenic were enhanced by 86.6 times for every increase of 1.0 MI. CONCLUSIONS Intraoperative MI best localized the epileptogenic zone immediately before sevoflurane reaching 2.0 MAC in this small cohort of patients. SIGNIFICANCE Prospective, large cohort studies are warranted to determine whether sevoflurane anesthesia can reduce the need for extraoperative, invasive evaluation.
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Affiliation(s)
- Keiko Wada
- Department of Anesthesiology, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo 1878551, Japan,Department of Anesthesiology and Critical Care, Yokohama City University Graduate School of Medicine, Yokohama, 2360004, Japan
| | - Masaki Sonoda
- Department of Pediatrics, Children’s Hospital of Michigan, Detroit Medical Center, Wayne State University, Detroit, MI 48201, USA,Department of Neurosurgery, Yokohama City University Graduate School of Medicine, Yokohama 2360004, Japan
| | - Ethan Firestone
- Department of Pediatrics, Children’s Hospital of Michigan, Detroit Medical Center, Wayne State University, Detroit, MI 48201, USA,Department of Physiology, Wayne State University, Detroit, MI 48201, USA
| | - Kazuki Sakakura
- Department of Pediatrics, Children’s Hospital of Michigan, Detroit Medical Center, Wayne State University, Detroit, MI 48201, USA,Department of Neurosurgery, University of Tsukuba, Tsukuba, 3058575, Japan
| | - Naoto Kuroda
- Department of Pediatrics, Children’s Hospital of Michigan, Detroit Medical Center, Wayne State University, Detroit, MI 48201, USA,Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai 9808575, Japan
| | - Yutaro Takayama
- Department of Neurosurgery, Yokohama City University Graduate School of Medicine, Yokohama 2360004, Japan,Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo 1878551, Japan
| | - Keiya Iijima
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo 1878551, Japan
| | - Masaki Iwasaki
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo 1878551, Japan
| | - Takahiro Mihara
- Department of Anesthesiology and Critical Care, Yokohama City University Graduate School of Medicine, Yokohama, 2360004, Japan,Department of Health Data Science, Yokohama City University Graduate School of Data Science, Yokohama, 2360027, Japan
| | - Takahisa Goto
- Department of Anesthesiology and Critical Care, Yokohama City University Graduate School of Medicine, Yokohama, 2360004, Japan
| | - Eishi Asano
- Department of Pediatrics, Children’s Hospital of Michigan, Detroit Medical Center, Wayne State University, Detroit, MI 48201, USA,Department of Neurology, Children’s Hospital of Michigan, Detroit Medical Center, Wayne State University, Detroit, MI 48201, USA,E.A. and T.M. share the senior authorship. Corresponding Authors: Eishi Asano, M.D., Ph.D., M.S. (C.R.D.S.A.), Address: Division of Pediatric Neurology, Children’s Hospital of Michigan, Wayne State University. 3901 Beaubien St., Detroit, MI, 48201, USA, Phone: +1-313-745-5547, FAX: +1-313-745-9435, and Tomoyuki Miyazaki, M.D., Ph.D., Address: Department of Physiology/Anesthesiology, Yokohama City University Graduate School of Medicine. 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, Japan, Phone: +81-45-787-2918, FAX: +81-45-787-2917,
| | - Tomoyuki Miyazaki
- Department of Anesthesiology and Critical Care, Yokohama City University Graduate School of Medicine, Yokohama, 2360004, Japan,Department of Physiology, Yokohama City University Graduate School of Medicine, Yokohama 2360004, Japan,E.A. and T.M. share the senior authorship. Corresponding Authors: Eishi Asano, M.D., Ph.D., M.S. (C.R.D.S.A.), Address: Division of Pediatric Neurology, Children’s Hospital of Michigan, Wayne State University. 3901 Beaubien St., Detroit, MI, 48201, USA, Phone: +1-313-745-5547, FAX: +1-313-745-9435, and Tomoyuki Miyazaki, M.D., Ph.D., Address: Department of Physiology/Anesthesiology, Yokohama City University Graduate School of Medicine. 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, Japan, Phone: +81-45-787-2918, FAX: +81-45-787-2917,
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Yamao Y, Matsumoto R, Kunieda T, Nakae T, Nishida S, Inano R, Shibata S, Kikuchi T, Arakawa Y, Yoshida K, Ikeda A, Miyamoto S. Effects of propofol on cortico-cortical evoked potentials in the dorsal language white matter pathway. Clin Neurophysiol 2021; 132:1919-1926. [PMID: 34182277 DOI: 10.1016/j.clinph.2021.04.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 03/22/2021] [Accepted: 04/24/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE In order to evaluate the clinical utility even under general anesthesia, the present study aimed to clarify the effect of anesthesia on the cortico-cortical evoked potentials (CCEPs). METHODS We analyzed 14 patients' data in monitoring the integrity of the dorsal language pathway by using CCEPs both under general anesthesia with propofol and remifentanil and awake condition, with the main aim of clarifying the effect of anesthesia on the distribution and waveform of CCEPs. RESULTS The distribution of larger CCEP response sites, including the locus of the maximum CCEP response site, was marginally affected by anesthesia. With regard to similarity of waveforms, the mean waveform correlation coefficient indicated a strong agreement. CCEP N1 amplitude increased by an average of 25.8% from general anesthesia to waking, except three patients. CCEP N1 latencies had no correlation in changes between the two conditions. CONCLUSIONS We demonstrated that the distribution of larger CCEP responses was marginally affected by anesthesia and that the CCEP N1 amplitude had tendency to increase from general anesthesia to the awake condition. SIGNIFICANCE The CCEP method provides the efficiency of intraoperative monitoring for dorsal language white matter pathway even under general anesthesia.
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Affiliation(s)
- Yukihiro Yamao
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Riki Matsumoto
- Division of Neurology, Kobe University Graduate School of Medicine, Kobe, Japan.
| | - Takeharu Kunieda
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Neurosurgery, Ehime University Graduate School of Medicine, Toon, Japan
| | - Takuro Nakae
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Sei Nishida
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Rika Inano
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Sumiya Shibata
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Physical Therapy, Niigata University of Health and Welfare, Niigata, Japan
| | - Takayuki Kikuchi
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yoshiki Arakawa
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kazumichi Yoshida
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akio Ikeda
- Epilepsy, Movement Disorders and Physiology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Susumu Miyamoto
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Kacar Bayram A, Yan Q, Isitan C, Rao S, Spencer DD, Alkawadri R. Effect of anesthesia on electrocorticography for localization of epileptic focus: Literature review and future directions. Epilepsy Behav 2021; 118:107902. [PMID: 33819715 DOI: 10.1016/j.yebeh.2021.107902] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 02/21/2021] [Accepted: 02/22/2021] [Indexed: 11/20/2022]
Abstract
Intraoperative electrocorticography (ECoG) is a useful technique to guide resections in epilepsy surgery and is mostly performed under general anesthesia. In this systematic literature review, we seek to investigate the effect of anesthetic agents on the quality and reliability of ECoG for localization of the epileptic focus. We conducted a systematic search using PubMed and EMBASE until January 2019, aiming to review the effects of anesthesia on ECoG yield. Fifty-eight studies were included from 1016 reviewed. There are favorable reports for dexmedetomidine and remifentanil during ECoG recording. There is inadequate, or sometimes conflicting, evidence to support using enflurane, isoflurane, sevoflurane, and propofol. There is evidence to avoid halothane, nitrous oxide, etomidate, ketamine, thiopental, methohexital, midazolam, fentanyl, and alfentanil due to undesired effects. Depth of anesthesia, intraoperative awareness, and surgical outcomes were not consistently evaluated. Available studies provide helpful information about the effect of anesthesia on ECoG to localize the epileptic focus. The proper use of anesthetic agents and careful dose titration, and effective communication between the neurophysiologist and anesthesiologist based on ECoG activity are essential in optimizing recordings. Anesthesia is a crucial variate to consider in the design of studies investigating ECoG and related biomarkers.
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Affiliation(s)
- Ayse Kacar Bayram
- Comprehensive Epilepsy Center, Dept. of Neurology, School of Medicine, Yale University, Yale New Haven Hospital, New Haven, CT, United States; Department of Pediatrics, Division of Pediatric Neurology, University of Health Sciences, Kayseri City Hospital, Kayseri, Turkey.
| | - Qi Yan
- Comprehensive Epilepsy Center, Dept. of Neurology, School of Medicine, Yale University, Yale New Haven Hospital, New Haven, CT, United States
| | - Cigdem Isitan
- Human Brain Mapping Program, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Shilpa Rao
- Department of Anesthesiology, School of Medicine, Yale University, New Haven, CT, United States
| | - Dennis D Spencer
- Comprehensive Epilepsy Center, Dept. of Neurology, School of Medicine, Yale University, Yale New Haven Hospital, New Haven, CT, United States
| | - Rafeed Alkawadri
- Comprehensive Epilepsy Center, Dept. of Neurology, School of Medicine, Yale University, Yale New Haven Hospital, New Haven, CT, United States; Human Brain Mapping Program, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
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Abstract
This paper is the fortieth consecutive installment of the annual anthological review of research concerning the endogenous opioid system, summarizing articles published during 2017 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides and receptors as well as effects of opioid/opiate agonists and antagonists. The review is subdivided into the following specific topics: molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors (1), the roles of these opioid peptides and receptors in pain and analgesia in animals (2) and humans (3), opioid-sensitive and opioid-insensitive effects of nonopioid analgesics (4), opioid peptide and receptor involvement in tolerance and dependence (5), stress and social status (6), learning and memory (7), eating and drinking (8), drug abuse and alcohol (9), sexual activity and hormones, pregnancy, development and endocrinology (10), mental illness and mood (11), seizures and neurologic disorders (12), electrical-related activity and neurophysiology (13), general activity and locomotion (14), gastrointestinal, renal and hepatic functions (15), cardiovascular responses (16), respiration and thermoregulation (17), and immunological responses (18).
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Affiliation(s)
- Richard J Bodnar
- Department of Psychology and Neuropsychology Doctoral Sub-Program, Queens College, City University of New York, CUNY, 65-30 Kissena Blvd., Flushing, NY, 11367, United States.
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Foged MT, Vinter K, Stauning L, Kjær TW, Ozenne B, Beniczky S, Paulson OB, Madsen FF, Pinborg LH. Verbal learning and memory outcome in selective amygdalohippocampectomy versus temporal lobe resection in patients with hippocampal sclerosis. Epilepsy Behav 2018; 79:180-187. [PMID: 29306849 DOI: 10.1016/j.yebeh.2017.12.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 12/07/2017] [Accepted: 12/08/2017] [Indexed: 11/16/2022]
Abstract
PURPOSE With the advent of new very selective techniques like thermal laser ablation to treat drug-resistant focal epilepsy, the controversy of resection size in relation to seizure outcome versus cognitive deficits has gained new relevance. The purpose of this study was to test the influence of the selective amygdalohippocampectomy (SAH) versus nonselective temporal lobe resection (TLR) on seizure outcome and cognition in patients with mesial temporal lobe epilepsy (MTLE) and histopathological verified hippocampal sclerosis (HS). METHODS We identified 108 adults (>16years) with HS, operated between 1995 and 2009 in Denmark. Exclusion criteria are the following: Intelligence below normal range, right hemisphere dominance, other native languages than Danish, dual pathology, and missing follow-up data. Thus, 56 patients were analyzed. The patients were allocated to SAH (n=22) or TLR (n=34) based on intraoperative electrocorticography. Verbal learning and verbal memory were tested pre- and postsurgery. RESULTS Seizure outcome did not differ between patients operated using the SAH versus the TLR at 1year (p=0.951) nor at 7years (p=0.177). Verbal learning was more affected in patients resected in the left hemisphere than in the right (p=0.002). In patients with left-sided TLR, a worsening in verbal memory performance was found (p=0.011). Altogether, 73% were seizure-free for 1year and 64% for 7years after surgery. CONCLUSION In patients with drug-resistant focal MTLE, HS and no magnetic resonance imaging (MRI) signs of dual pathology, selective amygdalohippocampectomy results in sustained seizure freedom and better memory function compared with patients operated with nonselective temporal lobe resection.
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Affiliation(s)
- Mette Thrane Foged
- Neurobiology Research Unit, Department of Neurology, Copenhagen University Hospital, Rigshospitalet, 28 Juliane Maries Vej, 3rd Floor, Building 6931, DK-2100 Copenhagen, Denmark
| | - Kirsten Vinter
- Epilepsy Clinic, Department of Neurology, Copenhagen University Hospital, Rigshospitalet, 8 Ester Møllers Vej, 1.th Floor, Entrance 85, DK-2100 Copenhagen, Denmark
| | - Louise Stauning
- Department of Neuropsychology, Danish Epilepsy Centre, 1 Kolonivej, DK-4293 Dianalund, Denmark
| | - Troels W Kjær
- Centre of Neurophysiology, Zealand University Hospital, 11 Vestermarksvej, Ground Floor, DK-4000 Roskilde, Denmark
| | - Brice Ozenne
- Department of Public Health, Section of Biostatistics, University of Copenhagen, 5 Øster Farimagsgade, DK-1014 Copenhagen, Denmark
| | - Sándor Beniczky
- Department of Clinical Neurophysiology, Danish Epilepsy Centre, 1 Kolonivej, DK-4293 Dianalund, Denmark; Department of Clinical Neurophysiology, Aarhus University, 44 Nørrebrogade, Ground Floor, Entrance 10, DK-8000 Aarhus C, Denmark
| | - Olaf B Paulson
- Neurobiology Research Unit, Department of Neurology, Copenhagen University Hospital, Rigshospitalet, 28 Juliane Maries Vej, 3rd Floor, Building 6931, DK-2100 Copenhagen, Denmark
| | - Flemming Find Madsen
- Department of Neurosurgery, Copenhagen University Hospital, Rigshospitalet, 7 Inge Lehmanns Vej, 9.th Floor, Entrance 2, DK-2100 Copenhagen, Denmark
| | - Lars H Pinborg
- Neurobiology Research Unit, Department of Neurology, Copenhagen University Hospital, Rigshospitalet, 28 Juliane Maries Vej, 3rd Floor, Building 6931, DK-2100 Copenhagen, Denmark; Epilepsy Clinic, Department of Neurology, Copenhagen University Hospital, Rigshospitalet, 8 Ester Møllers Vej, 1.th Floor, Entrance 85, DK-2100 Copenhagen, Denmark.
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