Intraoperative Electrocorticographic Monitoring for Predicting Post-Traumatic Seizures and Prognosticating Patients With Head Injury: A Prospective Observational Study.

BACKGROUND AND

OBJECTIVES

Post-traumatic epilepsy is a major complication of traumatic brain injury (TBI), with limited predictive tools and preventive strategies. Although intraoperative electrocorticography (ECoG) is widely used in epilepsy and tumor surgeries, its role in brain injury remains underexplored. This study evaluates the predictive value of intraoperative ECoG for seizure development and functional outcomes in patients with TBI.

METHODS

This prospective observational study included 110 patients with head injury who underwent surgery and intraoperative ECoG evaluation. The ECoG recordings were categorized as normal (Group A) or abnormal (Group B) based on epileptiform activity. Patients were followed for 12 months to assess seizure incidence, mortality, and functional outcomes using the International League Against Epilepsy, modified Rankin Scale, and Glasgow Outcome Scale. Statistical analysis was performed to determine associations between ECoG findings and clinical outcomes.

RESULTS

Among the 110 patients, 50 (45.5%) had normal ECoG, while 60 (54.5%) exhibited abnormal findings. Patients with abnormal intraoperative ECoG had significantly higher seizure incidence at 30 days ( P < .001, 95% CI = 2.36-138.1) and 6 months ( P < .001, 95% CI = 3.19-186.72). Burst suppression patterns were associated with 100% mortality. Functional outcomes were significantly worse in the abnormal ECoG group at 12 months, with higher modified Rankin Scale scores ( P < .001, 95% CI = 7.48-72.3) and lower Glasgow Outcome Scale scores ( P < .001, 95% CI = 3.86-51.55).

CONCLUSION

Intraoperative ECoG abnormalities correlate with increased seizure risk, higher mortality, and worse functional outcomes in patients with TBI. These findings suggest that intraoperative ECoG can serve as a prognostic tool, guiding antiseizure medication use and rehabilitation strategies in neurosurgical practice.