ORIGINAL ARTICLE   

Journal of Neurosurgical Sciences 2024 Apr 02

DOI: 10.23736/S0390-5616.24.06154-X

Copyright © 2024 EDIZIONI MINERVA MEDICA

lingua: Inglese

Intraoperative seizures during neuro-oncological supratentorial surgery: the role of prophylaxis with levetiracetam and intraoperative monitoring in a consecutive series of 353 patients

Francesca BATTISTA ¹ ✉, Giovanni MUSCAS ¹, Alberto PARENTI ¹, Maddalena SPALLETTI ², Cristiana MARTINELLI ², Riccardo CARRAI ², Andrea AMADORI ³, Alessandro DELLA PUPPA ¹

¹ Unit of Neurosurgery, Department of Neuroscience, Psychology, Drug Area and Child Health (NEUROFARBA), Careggi University Hospital, University of Florence, Florence, Italy; ² Unit of Neurophysiology, Department of Neuro-Muscular-Skeletal, Careggi University Hospital, University of Florence, Florence, Italy; ³ Neuro-Anesthesiology and Intensive Care Unit, Careggi University Hospital, University of Florence, Florence, Italy

BACKGROUND: The aim of this paper was to understand the role of prophylaxis with levetiracetam at skin incision in preventing convulsive intraoperative seizures (IOS) during neurosurgical procedures with and without intraoperative neuromonitoring (IONM).
METHODS: Authors retrospectively reviewed the Institutional database for cases of supratentorial brain tumors undergoing surgical resection performed from January 2021 to October 2022. Patients were operated on both under general anesthesia and awake, using motor-evoked potentials (MEP) and direct cortical stimulation for cortical mapping. 1000 mg ev of Levetiracetam before skin incision in case of a history of seizures was administrated. We excluded all infratentorial cases.
RESULTS: Three hundred fisty three consecutive cases were retrieved. IOS occurred in 22 patients (6.2%). Prophylaxis with Levetiracetam was administered in 149 patients, and IOS occurred in 16 cases (10.7%) in this group of patients. The IOS rate in the case of no Levetiracetam prophylaxis administration (3.5%) was significantly lower (P<0.001, OR=3.38 [1.35-8.45], RR=3.12 [1.32-7.41]). The Penfield technique stimulation evoked seven of all 22 IOS reported (31.8%) (P=0.006, RR 5.4 [1.44 -20.58], OR 21 [2.3-183.9]), and the train-of-five technique stimulation caused two of all registered IOS (8.7%) (P=0.2, RR 2.3 [0.99-5.67], OR 6.5 [0.55-76.17]). Transcranial MEPs evoked no IOS.
CONCLUSIONS: Under levetiracetam prophylaxis, the IOS rate was not significantly lower than in the group of patients without Levetiracetam prophylaxis, regardless of the histology of the tumor and IONM. Neither the transcranial stimulation (MEP) nor train-of-five technique stimulation increases the risk of convulsive IOS, as Penfield technique stimulation does.

KEY WORDS: Intraoperative neurophysiological monitoring; Anticonvulsants; Levetiracetam