Application of circular cerebral cortex electrodes in wake-up anaesthetic open cranial surgery

Backgroundabout 40%-70% of glioma patients have a brain tumor-related seizure (brain tumor-related epilepsy, BTRE)accurate location of eclampsia during surgery often relies on high-density cerebral cortex electrodesat present, there are limitations in the clinical use of strip electrodesKarim ReFaey, of the Mayo Clinic in Florida,, and others have studied a "ring electrode" (Figure 1) assembled by a 360-degree high-density circular cortex electrode that can guide both tumor removal and real-time electrophysiological data recording from the surface of the brainpaper was published online in J Neurosurg in July 2019Figure 1Left:ring electrodes;ring electrodes placed above the lesions for monitoring the electrical activity of 360 degreesthe studyincluded 99 PATIENTs with BTRE who had opened a cranial operation under wake-up anaesthetic from January to December 2008,29 cases using ring electrodes and 70 bar electrodes25 cases of the ring electrode were paired with 25 patients with the bar electrodeall operations were performed by two neurosurgeons under wake-up anaesthetic, with real-time electrophysiological data recording lasting an average of 9.75 minutes ring brain electrodes are placed at the surgical site by neuronavigation the results matched two groups of 25 patients with clinical data, including preoperative seizures, preoperative KPS scores, and other neurological symptoms were no different There was no significant difference in seizure condition sympathic condition between ring electrode group or bar electrode group, and there was no significant difference in postoperative seizure or postoperative KPS score however, the decrease of KPS score after the strip electrode group was more obvious, with the bar electrode group and the ring electrode group decreased by 11.6 points and 2 points respectively (p-0.007), and the tumor removal range (EOR) of the ring electrode group was greater than that of the bar electrode group, which was 92% and 77.6% (p.03), respectively two groups with one-off or permanent dysfunction were similar, but the ring electrode group showed motion function recovery (p.05) in 6.6 days after surgery the above results show that the patients of the ring electrode are superior to the striped electrode group in avoiding nerve function defects because the ring electrode is designed to wrap around a wider cerebral cortex, covering a wider range than a striped electrode, the removal rate is increased conclusion
the study shows that the ring electrode is a safe and feasible monitoring method, suitable for neurosurgery to remove tumor surgery at the same time, simultaneous monitoring of electroencephaloelectric activity, improve the accuracy of intraoperative epilepsy wave monitoring and reduce post-operative complications.