Localization of irritative zones in epilepsy with thermochromic silicone.

BACKGROUND: During epilepsy surgery, the gold standard to identify irritative zones (IZ) is electrocorticography (ECoG); however, new techniques are being developed to detect IZ in epilepsy surgery and in neurosurgery in general, such as infrared thermography mapping (ITM), and the use of thermosensitive/thermochromic materials. METHODS: In a cohort study of consecutive patients with focal drug-resistant epilepsy of the temporal lobe treated with surgery, we evaluated possible adverse effects to the transient placement of a thermochromic/thermosensitive silicone (TTS) on the cerebral cortex and their postoperative evolution. Furthermore, we compared the precision of TTS for detecting cortical IZ against the gold standard ECoG and with ITM, as proof of concept. RESULTS: We included 10 consecutive patients, 6 women (60%) and 4 men (40%). Age ranges from 15 to 56 years, mean 33.2 years. All were treated with unilateral temporal functional lobectomy. The mean hospital stay was 4 days. There were no immediate or late complications associated with the use of any of the modalities described. In the 10 patients, we obtained consistency in locating the IZ with ECoG, ITM, and the TTS. CONCLUSION: The TTS demonstrated biosecurity in this series. The accuracy of the TTS to locate IZ was similar to that of ECoG and ITM in this study. More extensive studies are required to determine its sensitivity and specificity.

Infrared thermography mapping plus neuronavigation target location in an eloquent area cavernoma resection.

BACKGROUND: Safety and efficacy are irrebuttable goals in neurosurgery. METHODS: We performed a subcortical cavernoma resection in an eloquent area, where we recorded and compared the maximal and minimal brain temperature measured by an infrared thermographic camera and thermometer with the neuronavigation (NN) target location and real anatomical lesion location. RESULTS: The hottest cortical point correlated to the subcortical cavernoma location. The NN located the target at 10 mm away from the hottest point. CONCLUSION: More studies are needed to better understand the thermic radiation of the brain in health and in disease, but we believe that evaluating brain temperature, it could be possible to improve accuracy in neurosurgery and generate more knowledge about brain metabolism in vivo.