Search

Few and contradictory data are available regarding intraoperative seizures (IOS) during surgery for Low Grade Gliomas (LGGs). Aim of this study was to evaluate the occurrence of IOS in regard to pre-operative clinical data, tumor molecular characteristics and electrocorticographic patterns. We performed a retrospective analysis of 155 patients affected by LGGs and tumor-related epilepsy, who underwent surgery in our Department, between 2007 and 2017. Pre-operative seizures frequency was as follows: 59% monthly, 34% weekly and 11% daily. 73% of patients were operated on through awake surgery. IOS occurred in 39 patients: in 9 patients only electrographic seizures occurred while in 13 patients seizures were cognitive, sensory, autonomic or emotional, thus recognizable only by means of electrocorticography (ECoG). Nineteen seizures were induced by brain mapping. Patients with ECoG epileptiform inter-critical patterns and IDH1/2 mutated tumors or oligodendrogliomas were more likely to develop IOS (p

Navigated transcranial magnetic stimulation (nTMS) is a novel technology in the field of neurosurgery for noninvasive delineation of cortical functional topography. Recent studies show that it can detect eloquent cortical areas directly, comparable to intraoperative direct cortical stimulation (DCS). The aim of this study was to evaluate the nTMS in comparison with functional magnetic resonance imaging (fMRI) in the setting of brain tumors involving motor areas. Thirteen consecutive patients affected by frontal lobe brain tumors were enrolled in the study. All patients received an fMRI and nTMS examination preoperatively. Consistency of preoperative mapping with intraoperative DCS was assessed off-line by means of the neuronavigation system: as result, nTMS produced statistically significant higher accuracy scores of the motor area localization than fMRI. Moreover, nTMS has fewer restrictions for preoperative functional mapping than fMRI and requires only a limited level of compliance: so it represents an useful and reliable technique during preoperative planning for surgical decision making in the clinical setting.

Bilateral globus pallidus deep brain stimulation (GPi-DBS) represents a validated, effective and relatively safe therapy for different forms of medically refractory dystonia. The goal of this study was to assess the effect of GPi-DBS in a homogeneous population of dystonic patients and to compare the clinical outcome using two different stimulation settings: a constant-current stimulation versus a constant-voltage stimulation. 22 patients affected by primary generalized or multisegmental dystonia underwent bilateral GPi-DBS. 13 patients were stimulated using a voltage-controlled setting while in the other 9 patients we used a current-controlled setting. Clinical features were evaluated for each patient at baseline, 6 months and 12 months after surgery by means of the Burke–Fahn–Marsden Dystonia Rating Scale (BFMDRS). In all the patients we found a statistically significant improvement both in motor and disability scores of BFMDRS. Moreover, we didn’t find any significant difference between current- and voltage-controlled stimulation at 6 and 12 months after surgery in comparison to baseline while a better improvement occured in the last 6 months follow-up in the current-controlled group. Our study shows that current-controlled stimulation could be more effective than voltage-controlled stimulation over long-term follow-up in dystonia.