Evaluation of WISE cortical strip electrodes for intraoperative neurophysiological monitoring during perirolandic brain surgery (WIN study)
EANS Academy. Szelenyi A. 10/04/21; 339434; EP11011
Andrea Szelenyi
Contributions
Contributions
Abstract
Background: Strip electrodes with embedded metal contacts are routinely used for intraoperative neurophysiological monitoring during brain surgery. For reliable application, the electrodes should have low impedance and sufficient adherence to record and stimulate directly on the brain surface. We aimed to evaluate safety, performance and usability of a novel strip electrode made by a thin polymer base with embedded metal nanoparticles (WCS, WISE Srl., Italy) for intraoperative use in perirolandic brain surgery.
Methods: In this multicentre prospective study, 32 patients undergoing tumour or epilepsy surgery close to the perirolandic region were included. WCS electrode-impedances at placement (P), after median nerve Somatosensory Evoked Potential-recording (SEP) and direct cortical stimulation (DCStim) were compared to standard commercial strip electrodes (Ad-Tech, USA). Safety including adverse events (AEs) was rated by an external clinical event committee; users rated usability per questionnaire.
Results: All 32 patients’ datasets could be analysed. The WCS was rated safe and effective in signal transmission both for recording and stimulation. 2 AEs (seizures) were classified as probably related to the stimulation with the WCS. Impedance values (median, interquartile range) for the WCS were lower at all time-points: P and SEP: 2.7 (2.3-3.7) vs 5.30 (4.3-6.6) kΩ; DCStim: 2.50 (1.8-3.1) vs 3.30 (2.8-4.1) kΩ, all p-values <0.005. The users rated WCS adhesion to the brain surface and stability against displacement as satisfactory. Limitation with respect to positioning was noted, due to its thinness, when partial exposure of the motor cortex required sliding of the WCS under the dura.
Conclusion: The WCS had significant lower impedance than the comparator which might be related to better adhesion and conformability to the brain surface. No limitations with respect to safety was noted. The WCS is suitable for direct recording and DCStim of the brain surface. In small keyhole craniotomies the use can be limited.
Methods: In this multicentre prospective study, 32 patients undergoing tumour or epilepsy surgery close to the perirolandic region were included. WCS electrode-impedances at placement (P), after median nerve Somatosensory Evoked Potential-recording (SEP) and direct cortical stimulation (DCStim) were compared to standard commercial strip electrodes (Ad-Tech, USA). Safety including adverse events (AEs) was rated by an external clinical event committee; users rated usability per questionnaire.
Results: All 32 patients’ datasets could be analysed. The WCS was rated safe and effective in signal transmission both for recording and stimulation. 2 AEs (seizures) were classified as probably related to the stimulation with the WCS. Impedance values (median, interquartile range) for the WCS were lower at all time-points: P and SEP: 2.7 (2.3-3.7) vs 5.30 (4.3-6.6) kΩ; DCStim: 2.50 (1.8-3.1) vs 3.30 (2.8-4.1) kΩ, all p-values <0.005. The users rated WCS adhesion to the brain surface and stability against displacement as satisfactory. Limitation with respect to positioning was noted, due to its thinness, when partial exposure of the motor cortex required sliding of the WCS under the dura.
Conclusion: The WCS had significant lower impedance than the comparator which might be related to better adhesion and conformability to the brain surface. No limitations with respect to safety was noted. The WCS is suitable for direct recording and DCStim of the brain surface. In small keyhole craniotomies the use can be limited.
Background: Strip electrodes with embedded metal contacts are routinely used for intraoperative neurophysiological monitoring during brain surgery. For reliable application, the electrodes should have low impedance and sufficient adherence to record and stimulate directly on the brain surface. We aimed to evaluate safety, performance and usability of a novel strip electrode made by a thin polymer base with embedded metal nanoparticles (WCS, WISE Srl., Italy) for intraoperative use in perirolandic brain surgery.
Methods: In this multicentre prospective study, 32 patients undergoing tumour or epilepsy surgery close to the perirolandic region were included. WCS electrode-impedances at placement (P), after median nerve Somatosensory Evoked Potential-recording (SEP) and direct cortical stimulation (DCStim) were compared to standard commercial strip electrodes (Ad-Tech, USA). Safety including adverse events (AEs) was rated by an external clinical event committee; users rated usability per questionnaire.
Results: All 32 patients’ datasets could be analysed. The WCS was rated safe and effective in signal transmission both for recording and stimulation. 2 AEs (seizures) were classified as probably related to the stimulation with the WCS. Impedance values (median, interquartile range) for the WCS were lower at all time-points: P and SEP: 2.7 (2.3-3.7) vs 5.30 (4.3-6.6) kΩ; DCStim: 2.50 (1.8-3.1) vs 3.30 (2.8-4.1) kΩ, all p-values <0.005. The users rated WCS adhesion to the brain surface and stability against displacement as satisfactory. Limitation with respect to positioning was noted, due to its thinness, when partial exposure of the motor cortex required sliding of the WCS under the dura.
Conclusion: The WCS had significant lower impedance than the comparator which might be related to better adhesion and conformability to the brain surface. No limitations with respect to safety was noted. The WCS is suitable for direct recording and DCStim of the brain surface. In small keyhole craniotomies the use can be limited.
Methods: In this multicentre prospective study, 32 patients undergoing tumour or epilepsy surgery close to the perirolandic region were included. WCS electrode-impedances at placement (P), after median nerve Somatosensory Evoked Potential-recording (SEP) and direct cortical stimulation (DCStim) were compared to standard commercial strip electrodes (Ad-Tech, USA). Safety including adverse events (AEs) was rated by an external clinical event committee; users rated usability per questionnaire.
Results: All 32 patients’ datasets could be analysed. The WCS was rated safe and effective in signal transmission both for recording and stimulation. 2 AEs (seizures) were classified as probably related to the stimulation with the WCS. Impedance values (median, interquartile range) for the WCS were lower at all time-points: P and SEP: 2.7 (2.3-3.7) vs 5.30 (4.3-6.6) kΩ; DCStim: 2.50 (1.8-3.1) vs 3.30 (2.8-4.1) kΩ, all p-values <0.005. The users rated WCS adhesion to the brain surface and stability against displacement as satisfactory. Limitation with respect to positioning was noted, due to its thinness, when partial exposure of the motor cortex required sliding of the WCS under the dura.
Conclusion: The WCS had significant lower impedance than the comparator which might be related to better adhesion and conformability to the brain surface. No limitations with respect to safety was noted. The WCS is suitable for direct recording and DCStim of the brain surface. In small keyhole craniotomies the use can be limited.
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