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Less-invasive subdural electrocorticography for investigation of spreading depolarizations in patients with subarachnoid hemorrhage.

作者信息

Meinert Franziska, Lemâle Coline L, Major Sebastian, Helgers Simeon O A, Dömer Patrick, Mencke Rik, Bergold Martin N, Dreier Jens P, Hecht Nils, Woitzik Johannes

机构信息

Department of Neurosurgery, Carl von Ossietzky University Oldenburg, Oldenburg, Germany.

Research Center Neurosensory Science, Carl von Ossietzky University Oldenburg, Oldenburg, Germany.

出版信息

Front Neurol. 2023 Jan 5;13:1091987. doi: 10.3389/fneur.2022.1091987. eCollection 2022.


DOI:10.3389/fneur.2022.1091987
PMID:36686541
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9849676/
Abstract

INTRODUCTION: Wyler-strip electrodes for subdural electrocorticography (ECoG) are the gold standard for continuous bed-side monitoring of pathological cortical network events, such as spreading depolarizations (SD) and electrographic seizures. Recently, SD associated parameters were shown to be (1) a marker of early brain damage after aneurysmal subarachnoid hemorrhage (aSAH), (2) the strongest real-time predictor of delayed cerebral ischemia currently known, and (3) the second strongest predictor of patient outcome at 7 months. The strongest predictor of patient outcome at 7 months was focal brain damage segmented on neuroimaging 2 weeks after the initial hemorrhage, whereas the initial focal brain damage was inferior to the SD variables as a predictor for patient outcome. However, the implantation of Wyler-strip electrodes typically requires either a craniotomy or an enlarged burr hole. Neuromonitoring an enlarged burr hole has been performed in only about 10% of the total patients monitored. METHODS: In the present pilot study, we investigated the feasibility of ECoG monitoring a less invasive burrhole approach using a Spencer-type electrode array, which was implanted subdurally rather than in the depth of the parenchyma. Seven aSAH patients requiring extraventricular drainage (EVD) were included. For electrode placement, the burr hole over which the EVD was simultaneously placed, was used in all cases. After electrode implantation, continuous, direct current (DC)/alternating current (AC)-ECoG monitoring was performed at bedside in our Neurointensive Care unit. ECoGs were analyzed following the recommendations of the Co-Operative Studies on Brain Injury Depolarizations (COSBID). RESULTS: Subdural Spencer-type electrode arrays permitted high-quality ECoG recording. During a cumulative monitoring period of 1,194.5 hours and a median monitoring period of 201.3 (interquartile range: 126.1-209.4) hours per patient, 84 SDs were identified. Numbers of SDs, isoelectric SDs and clustered SDs per recording day, and peak total SD-induced depression duration of a recording day were not significantly different from the previously reported results of the prospective, observational, multicenter, cohort, diagnostic phase III trial, DISCHARGE-1. No adverse events related to electrode implantation were noted. DISCUSSION: In conclusion, our findings support the safety and feasibility of less-invasive subdural electrode implantation for reliable SD-monitoring.

摘要
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2c9a/9849676/40836b0bc020/fneur-13-1091987-g0004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2c9a/9849676/012d0494837f/fneur-13-1091987-g0001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2c9a/9849676/fb90753786db/fneur-13-1091987-g0002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2c9a/9849676/d303b8210154/fneur-13-1091987-g0003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2c9a/9849676/40836b0bc020/fneur-13-1091987-g0004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2c9a/9849676/012d0494837f/fneur-13-1091987-g0001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2c9a/9849676/fb90753786db/fneur-13-1091987-g0002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2c9a/9849676/d303b8210154/fneur-13-1091987-g0003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2c9a/9849676/40836b0bc020/fneur-13-1091987-g0004.jpg

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Less-invasive subdural electrocorticography for investigation of spreading depolarizations in patients with subarachnoid hemorrhage.

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引用本文的文献

[1]
Proof-of-concept validation of noninvasive detection of cortical spreading depolarization with high-resolution direct current-electroencephalography with future device recommendations.

Imaging Neurosci (Camb). 2025-7-9

[2]
Comparative analysis of lumbar cerebrospinal fluid drainage versus lumbar puncture effectiveness in patients with aneurysmal subarachnoid hemorrhage.

Sci Rep. 2025-7-1

[3]
Automated detection of spreading depolarizations in electrocorticography.

Sci Rep. 2025-3-12

[4]
Acute-Phase Recording of the Spreading Depolarization Continuum in Aged Nonhuman Primates During Focal Ischemic Stroke.

Stroke. 2025-4

[5]
Proof-of-Concept Validation of Noninvasive Detection of Cortical Spreading Depolarization with High Resolution Direct Current-Electroencephalography.

medRxiv. 2025-2-1

[6]
Duration of spreading depression is the electrophysiological correlate of infarct growth in malignant hemispheric stroke.

J Cereb Blood Flow Metab. 2024-12

[7]
From spreading depolarization to blood-brain barrier dysfunction: navigating traumatic brain injury for novel diagnosis and therapy.

Nat Rev Neurol. 2024-7

[8]
Similarities in the Electrographic Patterns of Delayed Cerebral Infarction and Brain Death After Aneurysmal and Traumatic Subarachnoid Hemorrhage.

Transl Stroke Res. 2025-2

[9]
Comparative Study of Terminal Cortical Potentials Using Iridium and Ag/AgCl Electrodes.

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本文引用的文献

[1]
Subdural Placement of Electrocorticographic Electrode Array Through a Burr Hole Exposure: 2-Dimensional Operative Video.

Oper Neurosurg (Hagerstown). 2022-9-1

[2]
Depth-profile of impairments in endothelin-1 - induced focal cortical ischemia.

J Cereb Blood Flow Metab. 2022-10

[3]
Spreading depolarizations in ischaemia after subarachnoid haemorrhage, a diagnostic phase III study.

Brain. 2022-5-24

[4]
Neurologic Assessment of the Neurocritical Care Patient.

Front Neurol. 2021-3-22

[5]
Recovery from disorders of consciousness: mechanisms, prognosis and emerging therapies.

Nat Rev Neurol. 2021-3

[6]
Rapid Neuronal Ultrastructure Disruption and Recovery during Spreading Depolarization-Induced Cytotoxic Edema.

Cereb Cortex. 2020-9-3

[7]
Prognostic Value of Spreading Depolarizations in Patients With Severe Traumatic Brain Injury.

JAMA Neurol. 2020-4-1

[8]
Direct electrophysiological evidence that spreading depolarization-induced spreading depression is the pathophysiological correlate of the migraine aura and a review of the spreading depolarization continuum of acute neuronal mass injury.

Geroscience. 2020-2

[9]
Correlates of Spreading Depolarization, Spreading Depression, and Negative Ultraslow Potential in Epidural Versus Subdural Electrocorticography.

Front Neurosci. 2019-4-24

[10]
Cilostazol decreases duration of spreading depolarization and spreading ischemia after aneurysmal subarachnoid hemorrhage.

Ann Neurol. 2018-11-29

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