title: Brain tumors in eloquent areas: A European multicenter survey of intraoperative mapping techniques, intraoperative seizures occurrence, and antiepileptic drug prophylaxis.
abstract: Intraoperative mapping and monitoring techniques for eloquent area tumors are routinely used world wide. Very few data are available regarding mapping and monitoring methods and preferences, intraoperative seizures occurrence and perioperative antiepileptic drug management. A questionnaire was sent to 20 European centers with experience in intraoperative mapping or neurophysiological monitoring for the treatment of eloquent area tumors. Fifteen centers returned the completed questionnaires. Data was available on 2098 patients. 863 patients (41.1%) were operated on through awake surgery and intraoperative mapping, while 1235 patients (58.8%) received asleep surgery and intraoperative electrophysiological monitoring or mapping. There was great heterogeneity between centers with some totally AW oriented (up to 100%) and other almost totally ASL oriented (up to 92%) (31% SD). For awake surgery, 79.9% centers preferred an asleep-awake-asleep anesthesia protocol. Only 53.3% of the centers used ECoG or transcutaneous EEG. The incidence of intraoperative seizures varied significantly between centers, ranging from 2.5% to 54% (p < 0.001). It there appears to be a statistically significant link between the mastery of mapping technique and the risk of intraoperative seizures. Moreover, history of preoperative seizures can significantly increase the risk of intraoperative seizures (p < 0.001). Intraoperative seizures occurrence was similar in patients with or without perioperative drugs (12% vs. 12%, p = 0.2). This is the first European survey to assess intraoperative functional mapping and monitoring protocols and the management of peri- and intraoperative seizures. This data can help identify specific aspects that need to be investigated in prospective and controlled studies.
authors.affiliation: Clinic of Neurosurgery, Spedali Civili di Brescia, Scala 7, Piano 3°, Piazzale Spedali Civili 1, 25121, Brescia, Italy. giannantonios@hotmail.com.
authors.forename: Giannantonio
authors.initials: G
authors.lastname: Spena
authors.affiliation: Neurosurgery, Bern University Hospital, Bern, Switzerland.
authors.forename: Philippe
authors.initials: P
authors.lastname: Schucht
authors.affiliation: Neurology, Bern University Hospital, Bern, Switzerland.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Seidel
authors.affiliation: Neurosurgery, St Elisabeth Hospital, Tilburg, the Netherlands.
authors.forename: Geert-Jan
authors.initials: GJ
authors.lastname: Rutten
authors.affiliation: Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria.
authors.forename: Christian Franz
authors.initials: CF
authors.lastname: Freyschlag
authors.affiliation: Neuroscience, University of Turin, Turin, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: D'Agata
authors.affiliation: Clinic of Neurosurgery, Spedali Civili di Brescia, Scala 7, Piano 3°, Piazzale Spedali Civili 1, 25121, Brescia, Italy.
authors.forename: Emanule
authors.initials: E
authors.lastname: Costi
authors.affiliation: Clinic of Neurosurgery, Spedali Civili di Brescia, Scala 7, Piano 3°, Piazzale Spedali Civili 1, 25121, Brescia, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Zappa
authors.affiliation: Clinic of Neurosurgery, Spedali Civili di Brescia, Scala 7, Piano 3°, Piazzale Spedali Civili 1, 25121, Brescia, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Fontanella
authors.affiliation: Neurosurgery, Centre Hospitalier Universitaire de Nice, Nice, France.
authors.forename: Denys
authors.initials: D
authors.lastname: Fontaine
authors.affiliation: Neurosurgery, Centre Hospitalier Universitaire de Nice, Nice, France.
authors.forename: Fabien
authors.initials: F
authors.lastname: Almairac
authors.affiliation: Neurosurgery, Sant'Anna di Cona Hospital, Ferrara, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Cavallo
authors.affiliation: Neurosurgery, Sant'Anna di Cona Hospital, Ferrara, Italy.
authors.forename: Pasquale
authors.initials: P
authors.lastname: De Bonis
authors.affiliation: Neurosurgery, Hospital del Mar, Barcelona, Spain.
authors.forename: Gerardo
authors.initials: G
authors.lastname: Conesa
authors.affiliation: Neurosurgery, AHEPA University Hospital of Thessaloniki, Thessaloniki, Greece.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Foroglou
authors.affiliation: Neurosurgery, Grupo Hospitalario Quirón, Pozuelo de Alarcón, Spain.
authors.forename: Santiago
authors.initials: S
authors.lastname: Gil-Robles
authors.affiliation: Neurosurgery, Lariboisiere Hospital, Paris, France.
authors.forename: Emanuel
authors.initials: E
authors.lastname: Mandonnet
authors.affiliation: Neurosurgery, Hospital Universitario Marques de Valdecilla, Santander, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Martino
authors.affiliation: Neurosurgery, Charité Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Picht
authors.affiliation: Neurosurgery, Hospital Garcia de Orta, Almada, Portugal.
authors.forename: Catarina
authors.initials: C
authors.lastname: Viegas
authors.affiliation: Neurosurgery, Centre Hospitalier Universitaire de Poitiers, Poitiers, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Wager
authors.affiliation: Neurosurgery, Centre Hospitalier Sainte-Anne and Paris Descartes University, Paris, France.
authors.forename: Johan
authors.initials: J
authors.lastname: Pallud
mesh_terms: D000927:Anticonvulsants / Q000008:administration & dosage*; D001931:Brain Mapping / Q000379:methods*; D001932:Brain Neoplasms / Q000150:complications / Q000601:surgery*; D005060:Europe; D019538:Health Care Surveys; D006801:Humans; D007431:Intraoperative Complications; D064795:Intraoperative Neurophysiological Monitoring; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods; D012640:Seizures / Q000175:diagnosis* / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000927:Anticonvulsants
keywords: Brain mapping; Brain neoplasms; Epilepsy; Neurophysiological monitoring; Neurosurgeons