Pei-Sen Yao September 5, 2017

Journal of Neurosurgery, Ahead of Print. OBJECTIVE Using intraoperative electrocorticography (ECoG) to identify epileptogenic areas and improve postoperative seizure control in patients with low-grade gliomas (LGGs) remains inconclusive. In this study the authors retrospectively report on a surgery strategy that is based on intraoperative ECoG monitoring. METHODS A total of 108 patients with LGGs presenting at the onset of refractory seizures were included. Patients were divided into 2 groups. In Group I, all patients underwent gross-total resection (GTR) combined with resection of epilepsy areas guided by intraoperative ECoG, while patients in Group II underwent only GTR. Tumor location, tumor side, tumor size, seizure-onset features, seizure frequency, seizure duration, preoperative antiepileptic drug therapy, intraoperative electrophysiological monitoring, postoperative Engel class, and histological tumor type were compared between the 2 groups. RESULTS Univariate analysis demonstrated that tumor location and intraoperative ECoG monitoring correlated with seizure control. There were 30 temporal lobe tumors, 22 frontal lobe tumors, and 2 parietal lobe tumors in Group I, with 18, 24, and 12 tumors in those same lobes, respectively, in Group II (p < 0.05). In Group I, 74.07% of patients were completely seizure free (Engel Class I), while 38.89% in Group II (p < 0.05). In Group I, 96.30% of the patients achieved satisfactory postoperative seizure control (Engel Class I or II), compared with 77.78% in Group II (p < 0.05). Intraoperative ECoG monitoring indicated that in patients with temporal lobe tumors, most of the epileptic discharges (86.7%) were detected at the anterior part of the

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