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Abstract Details

Intraoperative Electrocorticography in Awake Brain Surgery: Comparing Three Electrode Configurations for Detecting Stimulus-induced and Spontaneous Epileptiform Activity
Epilepsy/Clinical Neurophysiology (EEG)
P7 - Poster Session 7 (8:00 AM-9:00 AM)
10-006
To compare three electrode designs—novel 22-contact circular grid, standard 6-contact strip, and standard high-density (HD) grid between 32 and 64 contacts—for the detection of epileptiform activity during awake craniotomy with electrocorticography (ECoG).

Electrode size and density are important in determining sensitivity in detecting epileptiform activity but electrode array may also be an important factor in considering the utility of ECoG during awake craniotomy and functional brain mapping (FBM).
This study included patients who underwent FBM with and without direct electrical stimulation (DES) during awake craniotomy with ECoG. Demographic, clinical, and ECoG data were collected.
A total of 194 patients were included, with 264 instances of electrode use: 113 circular grid, 96 strip electrode, and 55 HD grid. HD grid (15%) was used less to record ECoG during DES than circular grid (80%, p<0.001) and strip electrodes (69%, p<0.001). Sporadic interictal epileptiform activity was better detected with circular (45%, p<0.001) and HD grids (40%, p=0.006) compared to strip electrode (16%). Spontaneous seizures were recorded more frequently with circular grid (16%, p=0.018) compared to strip (9.4%) and HD grid (1.8%).  Afterdischarges were better detected by circular and HD grids (combined) compared to strip electrode (67% vs. 48%, p=0.024), at lower median stimulation intensity (3 mA vs. 5 mA, p<0.001). Multivariable analyses demonstrated circular grid (p<0.001) to be more sensitive in detecting spontaneous epileptiform activity than strip and HD grid electrodes, and both grids combined (circular and HD) to be better in recording stimulus-induced epileptiform activity than the strip electrode (p=0.01).
This study demonstrates higher rate of detection of epileptiform activity with circular and standard HD grids compared to strip electrode. Standard HD grid was used less during electrical stimulation and FBM, demonstrating importance of both the number of contacts and array when considering optimal conditions for ECoG during awake craniotomy and FBM.
Authors/Disclosures
Brin Freund, MD
PRESENTER 		Dr. Freund has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for UCB. Dr. Freund has received research support from Mayo Clinic.
Adrian Safa, MD Dr. Safa has nothing to disclose.
Alina Ivaniuk, MD Dr. Ivaniuk has nothing to disclose.
Anahita Jafari, MD Dr. Jafari has nothing to disclose.
Simidele O. Davis, MHS Mr. Davis has nothing to disclose.
David Sabsevitz No disclosure on file
Anteneh M. Feyissa, MD, MSc, FAAN (Mayo Clinic) Dr. Feyissa has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Neurelis.
Seyed M. Mirsattari, MD, PhD, FRCPC (Mayo Clinic) Dr. Mirsattari has nothing to disclose.
Sanjeet S. Grewal, MD Sanjeet S. Grewal, MD has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Medtronic.
Kaisorn Chaichana, MD Dr. Chaichana has nothing to disclose.
Alfredo Quinones-Hinojosa Alfredo Quinones-Hinojosa has nothing to disclose.
William O. Tatum IV, DO, FAAN (Mayo Clinic) Dr. Tatum has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Bioserenity. Dr. Tatum has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Natus. Dr. Tatum has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Neurelis. Dr. Tatum has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Elsevier. Dr. Tatum has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Defense Law Firm on behalf of a patient with epilepsy with funds donated to the Epilepsy Foundation of America. The institution of Dr. Tatum has received research support from Esai. The institution of Dr. Tatum has received research support from Mayo Clinic. The institution of Dr. Tatum has received research support from Liva Nova. The institution of Dr. Tatum has received research support from Engage Pharmaceuticals. The institution of Dr. Tatum has received research support from Xenon. Dr. Tatum has received intellectual property interests from a discovery or technology relating to health care. Dr. Tatum has received publishing royalties from a publication relating to health care. Dr. Tatum has received publishing royalties from a publication relating to health care. Dr. Tatum has received publishing royalties from a publication relating to health care. Dr. Tatum has a non-compensated relationship as a AAN Section Chair of Clinical Neurophysiology with AAN that is relevant to AAN interests or activities.