95829 Electrocorticogram at surgery (separate procedure)

Name of the Procedure:

Electrocorticogram (ECoG), Electrocorticography

Summary

An electrocorticogram is a medical procedure that records electrical activity from the brain’s cortex using electrodes placed directly on its surface. This is typically performed during brain surgery to help guide the procedure.

Purpose

ECoG is used to identify the areas of the brain responsible for functions like movement, sensation, or speech. It can aid in locating abnormal brain areas causing seizures or other neurological issues and guide surgical treatment to avoid critical regions of the brain.

Indications

• Evaluation of epilepsy or seizure disorders
• Mapping functional areas of the brain before neurosurgery
• Identification of brain regions responsible for specific neurological functions
• Patients with brain tumors, lesions, or other conditions requiring brain surgery

Preparation

• Patients may be instructed to fast for several hours before surgery.
• Medication adjustments may be needed, particularly if the patient is on anti-seizure drugs.
• Preoperative imaging (like MRI or CT scans) and neuropsychological testing might be performed to identify target areas.

Procedure Description

1. The patient is placed under general anesthesia.
2. The surgeon makes an incision in the scalp and creates an opening in the skull.
3. Electrode grids or strips are placed directly onto the brain’s surface.
4. Electrical activity is recorded from the brain while the patient may be awakened temporarily for functional mapping.
5. The information obtained guides the ongoing surgery.
6. The electrodes are removed, and the skull and scalp are closed.

Duration

The ECoG procedure typically takes several hours, depending on the complexity of the surgery and the extent of brain mapping required.

Setting

The procedure is performed in a hospital’s operating room, specifically equipped for neurosurgery.

Personnel

• Neurosurgeon
• Neurologist specializing in epilepsy
• Anesthesiologist
• Operating room nurses and technicians
• Neurophysiologist (to interpret brain activity)

Risks and Complications

• Infection
• Bleeding
• Seizures
• Temporary or permanent neurological impairments

• Swelling in the brain

  Any complication that arises is managed promptly by the surgical team.

Benefits

• Precise identification of epileptic foci or functional brain areas
• Increased success rate of neurological surgeries
• Minimization of neurological deficits post-surgery
• Improved outcomes for patients undergoing brain surgery

Recovery

• Patients will be monitored in a recovery room and then in an intensive care unit.
• Pain management and wound care are provided.
• Typical hospital stay ranges from a few days to a week.
• Restrictions on activities vary; some patients might need rehabilitation services.
• Follow-up appointments are essential for monitoring recovery and adjusting any medications.

Alternatives

• Non-invasive neuroimaging techniques (e.g., MRI, PET scans)
• Scalp electroencephalogram (EEG)
• Magnetoencephalography (MEG)

The alternative methods may be less precise but safer since they avoid direct brain contact.

Patient Experience

During the procedure, patients are under anesthesia and will not feel any discomfort. If the patient is awakened for functional mapping, minimal discomfort is managed by anesthetics. Post-procedure, patients might experience headaches, fatigue, and typical surgical pain managed with medications and supportive care.