Article
Semi-invasive placement of cortical electrocorticographic grids during implantation of external ventricular drain for assessment of spreading depolarisation
Semi-invasive Implantation kortikaler Elektrokortikographie-Elektroden im Rahmen der Anlage einer externen Ventrikeldrainage für die Untersuchung von Spreading Depolarizations
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Authors
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Franziska Meinert
- Evangelisches Krankenhaus Oldenburg, Universitätsklinik für Neurochirurgie, Oldenburg, Deutschland
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Patrick Dömer
- Evangelisches Krankenhaus Oldenburg, Universitätsklinik für Neurochirurgie, Oldenburg, Deutschland
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Simeon Helgers
- Evangelisches Krankenhaus Oldenburg, Universitätsklinik für Neurochirurgie, Oldenburg, Deutschland
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Renán Sánchez Porras
- Evangelisches Krankenhaus Oldenburg, Universitätsklinik für Neurochirurgie, Oldenburg, Deutschland
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Max Schrammel
- Evangelisches Krankenhaus Oldenburg, Universitätsklinik für Neurochirurgie, Oldenburg, Deutschland
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Edgar Santos
- Evangelisches Krankenhaus Oldenburg, Universitätsklinik für Neurochirurgie, Oldenburg, Deutschland
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Nils Hecht
- Charité – Universitätsmedizin Berlin, Klinik für Neurochirurgie, Berlin, Deutschland
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Martin Bergold
- Evangelisches Krankenhaus Oldenburg, Anaesthesiology, Oldenburg, Deutschland
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Christian Byhahn
- Evangelisches Krankenhaus Oldenburg, Anaesthesiology, Oldenburg, Deutschland
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Johannes Woitzik
- Evangelisches Krankenhaus Oldenburg, Universitätsklinik für Neurochirurgie, Oldenburg, Deutschland
| Published: | May 25, 2022 |
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Outline
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Objective: Detection of early secondary injury is crucial for better outcome in patients with malignant stroke, spontaneous aneurysmatic subarachnoid haemorrhage or traumatic brain injury. Intracranial electrocorticography (ECoG) is an important part of multimodal continuous bed-side and real-time monitoring and is used to detect pathological cortical network events such as spreading depolarizations (SD) as well as ictal epileptiform events (IEE). The early detection allows intervention prior to tissue damage, hence monitoring SDs becomes more important and has an increasing impact on therapeutic decision making. While ECoG grids are commonly implanted during craniotomy or hemicraniectomy, we present a less invasive approach of ECoG electrode implantation in patients who undergo minimal invasive surgery such as burr hole craniotomy.
Methods: A burr hole craniotomy was performed for insertion of a ventricular drain. During this procedure an implantation of a spencer-type depth electrode was performed. A cottonoid was placed on the cortex for protection and to permit gentle pressure of the cortical surface. Subsequently, the electrode stylet was retracted in a stepwise-fashion and the electrode was advanced carefully into the subdural space until all contacts were completely inserted. Afterwards, the cottonoid was removed and the electrode was tunneled with a peripheral venous line.
Results: Placing the ECoG electrode via burr hole craniotomy is feasible. In a first group of 7 patients with subarachnoid haemorrhage, ECoG monitoring was performed over an average period of 167.25h. No infection or other complications in association with electrode implantation were noted. SDs were observed in 3 patients (mean 22.3 SDs ± 8.37). In 2 of those patients, SDs occurred in clusters. For inhibition of these cluster SDs, esketamine treatment was performed for 3 and 5 days respectively, resulting in an effective suppression of SD-clusters.
Conclusion: We illustrated the feasibility of a less-invasive electrode implantation technique that merely requires a burr hole craniotomy and opens the possibility of routine ECoG electrode implantation in patients who do not require a primary surgical procedure. This multimodal bed-side neuromonitoring allows an early therapeutic intervention in response to pathological cortical network events, even in non-responsive patients.
