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Brain tumors in eloquent areas: A European multicenter survey of intraoperative mapping techniques, intraoperative seizures occurrence, and antiepileptic drug prophylaxis

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Abstract

Intraoperative mapping and monitoring techniques for eloquent area tumors are routinely used world wide. Very few data are available regarding mapping and monitoring methods and preferences, intraoperative seizures occurrence and perioperative antiepileptic drug management. A questionnaire was sent to 20 European centers with experience in intraoperative mapping or neurophysiological monitoring for the treatment of eloquent area tumors. Fifteen centers returned the completed questionnaires. Data was available on 2098 patients. 863 patients (41.1%) were operated on through awake surgery and intraoperative mapping, while 1235 patients (58.8%) received asleep surgery and intraoperative electrophysiological monitoring or mapping. There was great heterogeneity between centers with some totally AW oriented (up to 100%) and other almost totally ASL oriented (up to 92%) (31% SD). For awake surgery, 79.9% centers preferred an asleep-awake-asleep anesthesia protocol. Only 53.3% of the centers used ECoG or transcutaneous EEG. The incidence of intraoperative seizures varied significantly between centers, ranging from 2.5% to 54% (p < 0.001). It there appears to be a statistically significant link between the mastery of mapping technique and the risk of intraoperative seizures. Moreover, history of preoperative seizures can significantly increase the risk of intraoperative seizures (p < 0.001). Intraoperative seizures occurrence was similar in patients with or without perioperative drugs (12% vs. 12%, p = 0.2). This is the first European survey to assess intraoperative functional mapping and monitoring protocols and the management of peri- and intraoperative seizures. This data can help identify specific aspects that need to be investigated in prospective and controlled studies.

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Abbreviations

AAA:

awake-awake-awake anesthesia protocol

AED:

antiepileptic drug

SAS:

asleep-awake-asleep anesthesia protocol

ASL:

asleep surgery

AW:

awake surgery

ECoG:

electrocorticography

EEG:

electroencephalography

MEP:

motor evoked potential

IS:

intraoperative seizure

SD:

standard deviation

IQR:

interquartile range

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Acknowledgments

Pasquale DE BONIS thanks Giulia Ghisellini (medical student) for the data collection.

Johan PALLUD thanks Edouard Dezamis, Marc Zanello (neurosurgeons) and Odile Rigau-Viodé (speech therapist).

Giannantonio SPENA thanks Pier Paolo Panciani (neurosurgeon) for the intellectual support.

Author information

Authors and Affiliations

  1. Clinic of Neurosurgery, Spedali Civili di Brescia, Scala 7, Piano 3°, Piazzale Spedali Civili 1, 25121, Brescia, Italy

    Giannantonio Spena, Emanule Costi, Francesca Zappa & Marco Fontanella

  2. Neurosurgery, Bern University Hospital, Bern, Switzerland

    Philippe Schucht

  3. Neurology, Bern University Hospital, Bern, Switzerland

    Kathleen Seidel

  4. Neurosurgery, St Elisabeth Hospital, Tilburg, the Netherlands

    Geert-Jan Rutten

  5. Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria

    Christian Franz Freyschlag

  6. Neuroscience, University of Turin, Turin, Italy

    Federico D’Agata

  7. Neurosurgery, Centre Hospitalier Universitaire de Nice, Nice, France

    Denys Fontaine & Fabien Almairac

  8. Neurosurgery, Sant’Anna di Cona Hospital, Ferrara, Italy

    Michele Cavallo & Pasquale De Bonis

  9. Neurosurgery, Hospital del Mar, Barcelona, Spain

    Gerardo Conesa

  10. Neurosurgery, AHEPA University Hospital of Thessaloniki, Thessaloniki, Greece

    Nicholas Foroglou

  11. Neurosurgery, Grupo Hospitalario Quirón, Pozuelo de Alarcón, Spain

    Santiago Gil-Robles

  12. Neurosurgery, Lariboisiere Hospital, Paris, France

    Emanuel Mandonnet

  13. Neurosurgery, Hospital Universitario Marques de Valdecilla, Santander, Spain

    Juan Martino

  14. Neurosurgery, Charité Universitätsmedizin Berlin, Berlin, Germany

    Thomas Picht

  15. Neurosurgery, Hospital Garcia de Orta, Almada, Portugal

    Catarina Viegas

  16. Neurosurgery, Centre Hospitalier Universitaire de Poitiers, Poitiers, France

    Michel Wager

  17. Neurosurgery, Centre Hospitalier Sainte-Anne and Paris Descartes University, Paris, France

    Johan Pallud

Authors
  1. Giannantonio Spena
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  2. Philippe Schucht
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  3. Kathleen Seidel
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  4. Geert-Jan Rutten
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  5. Christian Franz Freyschlag
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  6. Federico D’Agata
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  9. Marco Fontanella
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  12. Michele Cavallo
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  13. Pasquale De Bonis
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  14. Gerardo Conesa
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  15. Nicholas Foroglou
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  16. Santiago Gil-Robles
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  17. Emanuel Mandonnet
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  18. Juan Martino
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  19. Thomas Picht
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  20. Catarina Viegas
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  21. Michel Wager
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  22. Johan Pallud
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Corresponding author

Correspondence to Giannantonio Spena.

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Spena, G., Schucht, P., Seidel, K. et al. Brain tumors in eloquent areas: A European multicenter survey of intraoperative mapping techniques, intraoperative seizures occurrence, and antiepileptic drug prophylaxis. Neurosurg Rev 40, 287–298 (2017). https://doi.org/10.1007/s10143-016-0771-2

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  • DOI: https://doi.org/10.1007/s10143-016-0771-2

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