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Lee, Hur, Kim, Moon, Kim, Kim, Kwon, Park, and Chung: Clinical Efficacy of Acute Monitoring Cortical Activity Using Subdural Strip Electrode after Decompressive Craniectomy
Clinical Article

Korean J Nutr 2013;9(2):96-100.

Published online: 20 October 2013

DOI: https://doi.org/10.13004/kjnt.2013.9.2.96

Clinical Efficacy of Acute Monitoring Cortical Activity Using Subdural Strip Electrode after Decompressive Craniectomy

Ji Hye Lee, MD, Jun Seok Hur, MD, Beom Joon Kim, MD, Hong Joo Moon, MD, Jong Hyun Kim, MD, Joo Han Kim, MD, Taek Hyun Kwon, MD, Youn Kwan Park, MD, Heung Seob Chung, MD

Department of Neurosurgery, Korea University College of Medicine, Guro Hospital, Seoul, Korea

Address for correspondence: Jong Hyun Kim, MD Department of Neurosurgery, Korea University College of Medicine, Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul 152-703, Koea Tel: +82-2-2626-3098, Fax: +82-2-863-1684 E-mail: jhkimns@gmail.com

Received 21 August 2013       Revised 21 September 2013       Accepted 21 September 2013

Copyright © 2013 The Korean Nutrition Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective

Decompressive craniectomy is widely used in cases of uncontrolled intracranial hypertension, including traumatic brain injury or acute stroke. Physiological monitorings, such as intracranial pressure or electroenecephalography (EEG) are critical for patients in the acute phase. We retrospectively reviewed our experience of continuous electrocorticography (ECoG) monitoring by subdural strip electrode in patients who performed decompressive craniectomy and assessed its clinical efficacy.

Methods

Patients who underwent decompressive craniectomy because of severe intracranial hypertension were included. 4 Channel strip electrodes were inserted on the frontal cortex before closure. 24-hour continuous monitoring of ECoG was done to identify abnormal electrical activity. The level of consciousness was assessed according to Glasgow Coma Scale (GCS). In patients with malignant intracranial hypertension, barbiturate coma therapy was considered.

Results

Fifteen patients (9 men and 6 women) were included and the mean age was 55.7 years (from 17 to 80). The initial mean GCS score was 7.9 (from 3 to 14). In six out of fifteen patients, abnormal spike activities were identified, and one of these six patients was diagnosed as nonconvulsive status epilepticus (NCSE). Cortical spreading depression (CSD) was suspected in five. Three patients underwent barbiturate coma therapy and ECoG monitoring of these patients showed typical burst suppression pattern, which was used for indicator of therapeutic level. The mean duration of strip electrode and ECoG monitoring was 3.5 days, and there was no complication.

Conclusion

Continuous ECoG monitoring using subdural strip electrode was useful to detect abnormal brain activity in the acute period after decompressive craniectomy.

Keywords: Subdural electrode, Electrocorticography, Traumatic brain injury, Status epilepticus, Cortical spreading depression, Burst suppression

References

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FIGURE 1.
A: 4-channel strip electrode. The width of electrode is 5 mm and the gap between electrodes is 10 mm. B: Skull X-ray (lateral view) after decompressive craniectomy. Subdural strip electrode (arrow) was inserted.
kjn-9-96f1.tif
FIGURE 2.
A: Nonconvulsive status epilepticus in patient with acute subdural hematoma (Patient No.10). Abnormal fast spiking activities are shown in all channels when patient showed ictal nystagmus and decrease of consciousness. B: Cortical spreading depression in patient with subarachnoid hemorrhage (Patient No.2). Time-compressed tracing shows depressed ECoG activity (arrowhead), about 60% reduction of amplitude, evolved over 30 seconds and lasted for about 5 minutes in upper row. This is followed by a similar change in lower row about 4 minutes later. The distance of each contact of strip electrode is 10 mm, so the propagation rate is about 2 mm/min. C: Burst-suppression pattern of ECoG activity in patient with barbiturate coma therapy (Patient No. 1). Bursting activities (arrows) are shown in all channels after several seconds period of suppressed ECoG. ECoG: electrocorticogram.
kjn-9-96f2.tif
TABLE 1.
Demographics of the study population
Case no. Sex Age Diagnosis Initial GCS∗ Duration (days) Coma therapy ECoG finding
1 M 54 ASDH 11 (2–4–5) 5 (+) CSD
2 F 54 SAH 11 (3–3–5) 3 – CSD
3 M 24 Lymphoma 4 (1–1–2) 4 (+) NS
4 M 46 Infarction 11 (3–3–5) 3 – CSD
5 F 63 SAH 14 (3–5–6)† 2 – Spike (+)
6 M 57 Infarction 11 (3–3–5) 2 – NS
7 F 66 Infarction 7 (1–1–5) 3 – Spike (+), CSD
8 F 17 Encephalitis 3 (1–1–1) 4 (+) Spike (+)
9 M 43 ICH 4 (1–1–2) 3 – Spike (+), CSD
10 F 80 ASDH 4 (1–1–2) 3 – Status epilepticus
11 M 67 ICH 4 (1–1–2) 5 – NS
12 F 71 ASDH 8 (2–1–5) 4 – Spike (+)
13 M 66 ASDH 4 (1–1–2) 2 – NS
14 M 53 Infraction 11 (3–3–5) 2 – NS
15 M 74 ASDH 11 (3–3–5) 3 – NS

∗ GCS score (eye-verbal-motor response),

† severe brain swelling was noted intraoperatively. ASDH: acute subdural hemorrhage, SAH: subarachnoid hemorrhage, ICH: intracerebral hemorrhage, GCS: Glasgow Coma Scale, EEG: electroencephalogram, CSD: cortical spreading depression, NS: not significant

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