{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T12:50:53Z","timestamp":1783774253334,"version":"3.55.0"},"reference-count":18,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2017,1]]},"abstract":"\nOBJECTIVE<\/jats:title>\nCortical spreading depression (CSD) has been observed with relatively high frequency in the period following human brain injury, including traumatic brain injury and ischemic\/hemorrhagic stroke. These events are characterized by loss of ionic gradients through massive cellular depolarization, neuronal dysfunction (depression of electrocorticographic [ECoG] activity) and slow spread (2\u20135 mm\/min) across the cortical surface. Previous data obtained in animals have suggested that even in the absence of underlying injury, neurosurgical manipulation can induce CSD and could potentially be a modifiable factor in neurosurgical injury. The authors report their initial experience with direct intraoperative ECoG monitoring for CSD.<\/jats:p><\/jats:sec>\n\nMETHODS<\/jats:title>\nThe authors prospectively enrolled patients undergoing elective craniotomy for supratentorial lesions in cases in which the surgical procedure was expected to last > 2 hours. These patients were monitored for CSD from the time of dural opening through the time of dural closure, using a standard 1 \u00d7 6 platinum electrode coupled with an AC or full-spectrum DC amplifier. The data were processed using standard techniques to evaluate for slow potential changes coupled with suppression of high-frequency ECoG propagating across the electrodes. Data were compared with CSD validated in previous intensive care unit (ICU) studies, to evaluate recording conditions most likely to permit CSD detection, and identify likely events during the course of neurosurgical procedures using standard criteria.<\/jats:p><\/jats:sec>\n\nRESULTS<\/jats:title>\nEleven patients underwent ECoG monitoring during elective neurosurgical procedures. During the periods of monitoring, 2 definite CSDs were observed to occur in 1 patient and 8 suspicious events were detected in 4 patients. In other patients, either no events were observed or artifact limited interpretation of the data. The DC-coupled amplifier system represented an improvement in stability of data compared with AC-coupled systems. Compared with more widely used postoperative ICU monitoring, there were additional challenges with artifact from saturation during bipolar cautery as well as additional noise peaks detected.<\/jats:p><\/jats:sec>\n\nCONCLUSIONS<\/jats:title>\nCSD can occur during elective neurosurgical procedures even in brain regions distant from the immediate operative site. ECoG monitoring with a DC-coupled full-spectrum amplifier seemed to provide the most stable signal despite significant challenges to the operating room environment. CSD may be responsible for some cases of secondary surgical injury. Though further studies on outcome related to the occurrence of these events is needed, efforts to decrease the occurrence of CSD by modification of anesthetic regimen may represent a novel target for study to increase the safety of neurosurgical procedures.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2015.11.jns151871","type":"journal-article","created":{"date-parts":[[2016,3,11]],"date-time":"2016-03-11T14:59:32Z","timestamp":1457708372000},"page":"266-273","source":"Crossref","is-referenced-by-count":15,"title":["Cortical spreading depression occurs during elective neurosurgical procedures"],"prefix":"10.3171","volume":"126","author":[{"given":"Andrew P.","family":"Carlson","sequence":"first","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"William Shuttleworth","sequence":"additional","affiliation":[{"name":"Neurosciences, University of New Mexico School of Medicine, Albuquerque, New Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brittany","family":"Mead","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brittany","family":"Burlbaw","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Krasberg","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Howard","family":"Yonas","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-jns151871","series-title":"Neurosurgery","first-page":"1052","article-title":"A review of brain retraction and recommendations for minimizing intraoperative brain injury","volume":"33","author":"Andrews RJ,","year":"1993","unstructured":"Andrews RJ, Bringas JR: A review of brain retraction and recommendations for minimizing intraoperative brain injury. Neurosurgery 33:1052\u20131064, 19938133991"},{"key":"b2-jns151871","series-title":"Ann Neurol","doi-asserted-by":"publisher","first-page":"652","DOI":"10.1002\/ana.20778","article-title":"Suppression of cortical spreading depression in migraine prophylaxis","volume":"59","author":"Ayata C,","year":"2006","unstructured":"Ayata C, Jin H, Kudo C, Dalkara T, Moskowitz MA: Suppression of cortical spreading depression in migraine prophylaxis. Ann Neurol 59:652\u2013661, 200610.1002\/ana.2077816450381"},{"key":"b3-jns151871","series-title":"Ann Neurol","doi-asserted-by":"publisher","first-page":"607","DOI":"10.1002\/ana.21943","article-title":"Recurrent spreading depolarizations after subarachnoid hemorrhage decreases oxygen availability in human cerebral cortex","volume":"67","author":"Bosche B,","year":"2010","unstructured":"Bosche B, Graf R, Ernestus RI, Dohmen C, Reithmeier T, Brinker G, : Recurrent spreading depolarizations after subarachnoid hemorrhage decreases oxygen availability in human cerebral cortex. Ann Neurol 67:607\u2013617, 201010.1002\/ana.2194320437558"},{"key":"b4-jns151871","series-title":"Neurol Res","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1179\/1743132811Y.0000000077","article-title":"Vascular, electrophysiological, and metabolic consequences of cortical spreading depression in a mouse model of simulated neurosurgical conditions","volume":"34","author":"Carlson AP,","year":"2012","unstructured":"Carlson AP, Carter RE, Shuttleworth CW: Vascular, electrophysiological, and metabolic consequences of cortical spreading depression in a mouse model of simulated neurosurgical conditions. Neurol Res 34:223\u2013231, 201210.1179\/1743132811Y.0000000077"},{"key":"b5-jns151871","series-title":"J Neurosci","doi-asserted-by":"publisher","first-page":"8014","DOI":"10.1523\/JNEUROSCI.0765-08.2008","article-title":"Zn2+ influx is critical for some forms of spreading depression in brain slices","volume":"28","author":"Dietz RM,","year":"2008","unstructured":"Dietz RM, Weiss JH, Shuttleworth CW: Zn2+ influx is critical for some forms of spreading depression in brain slices. J Neurosci 28:8014\u20138024, 200810.1523\/JNEUROSCI.0765-08.200818685026"},{"key":"b6-jns151871","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"1457","DOI":"10.1097\/00006123-200212000-00017","article-title":"Ischemia triggered by red blood cell products in the subarachnoid space is inhibited by nimodipine administration or moderate volume expansion\/hemodilution in rats","volume":"51","author":"Dreier JP,","year":"2002","unstructured":"Dreier JP, Windm\u00fcller O, Petzold G, Lindauer U, Einh\u00e4upl KM, Dirnagl U: Ischemia triggered by red blood cell products in the subarachnoid space is inhibited by nimodipine administration or moderate volume expansion\/hemodilution in rats. Neurosurgery 51:1457\u20131467, 20021244535210.1097\/00006123-200212000-00017"},{"key":"b7-jns151871","series-title":"Brain","doi-asserted-by":"publisher","first-page":"3224","DOI":"10.1093\/brain\/awl297","article-title":"Delayed ischaemic neurological deficits after subarachnoid haemorrhage are associated with clusters of spreading depolarizations","volume":"129","author":"Dreier JP,","year":"2006","unstructured":"Dreier JP, Woitzik J, Fabricius M, Bhatia R, Major S, Drenckhahn C, : Delayed ischaemic neurological deficits after subarachnoid haemorrhage are associated with clusters of spreading depolarizations. Brain 129:3224\u20133237, 200610.1093\/brain\/awl29717067993"},{"key":"b8-jns151871","series-title":"Lancet Neurol","doi-asserted-by":"publisher","first-page":"1058","DOI":"10.1016\/S1474-4422(11)70243-5","article-title":"Spreading depolarisations and outcome after traumatic brain injury: a prospective observational study","volume":"10","author":"Hartings JA,","year":"2011","unstructured":"Hartings JA, Bullock MR, Okonkwo DO, Murray LS, Murray GD, Fabricius M, : Spreading depolarisations and outcome after traumatic brain injury: a prospective observational study. Lancet Neurol 10:1058\u20131064, 20112205615710.1016\/S1474-4422(11)70243-5"},{"key":"b9-jns151871","series-title":"J Neurosci","doi-asserted-by":"publisher","first-page":"11602","DOI":"10.1523\/JNEUROSCI.23-37-11602.2003","article-title":"Delayed secondary phase of peri-infarct depolarizations after focal cerebral ischemia: relation to infarct growth and neuroprotection","volume":"23","author":"Hartings JA,","year":"2003","unstructured":"Hartings JA, Rolli ML, Lu XC, Tortella FC: Delayed secondary phase of peri-infarct depolarizations after focal cerebral ischemia: relation to infarct growth and neuroprotection. J Neurosci 23:11602\u201311610, 20031468486210.1523\/JNEUROSCI.23-37-11602.2003"},{"key":"b10-jns151871","series-title":"J Neurophysiol","doi-asserted-by":"publisher","first-page":"2563","DOI":"10.1152\/jn.00345.2009","article-title":"Recovery of slow potentials in AC-coupled electrocorticography: application to spreading depolarizations in rat and human cerebral cortex","volume":"102","author":"Hartings JA,","year":"2009","unstructured":"Hartings JA, Watanabe T, Dreier JP, Major S, Vendelbo L, Fabricius M: Recovery of slow potentials in AC-coupled electrocorticography: application to spreading depolarizations in rat and human cerebral cortex. J Neurophysiol 102:2563\u20132575, 20091949419210.1152\/jn.00345.2009"},{"key":"b11-jns151871","series-title":"Brain","doi-asserted-by":"publisher","first-page":"2390","DOI":"10.1093\/brain\/aws152","article-title":"Effect of analgesics and sedatives on the occurrence of spreading depolarizations accompanying acute brain injury","volume":"135","author":"Hertle DN,","year":"2012","unstructured":"Hertle DN, Dreier JP, Woitzik J, Hartings JA, Bullock R, Okonkwo DO, : Effect of analgesics and sedatives on the occurrence of spreading depolarizations accompanying acute brain injury. Brain 135:2390\u20132398, 20122271900110.1093\/brain\/aws152"},{"key":"b12-jns151871","series-title":"J Cereb Blood Flow Metab","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1038\/jcbfm.2010.191","article-title":"Clinical relevance of cortical spreading depression in neurological disorders: migraine, malignant stroke, subarachnoid and intracranial hemorrhage, and traumatic brain injury","volume":"31","author":"Lauritzen M,","year":"2011","unstructured":"Lauritzen M, Dreier JP, Fabricius M, Hartings JA, Graf R, Strong AJ: Clinical relevance of cortical spreading depression in neurological disorders: migraine, malignant stroke, subarachnoid and intracranial hemorrhage, and traumatic brain injury. J Cereb Blood Flow Metab 31:17\u201335, 20112104586410.1038\/jcbfm.2010.191"},{"key":"b13-jns151871","series-title":"J Neurophysiol","doi-asserted-by":"publisher","first-page":"409","DOI":"10.1152\/jn.1947.10.6.409","article-title":"Further observations on the spreading depression of activity in the cerebral cortex","volume":"10","author":"Leao AA:","year":"1947","unstructured":"Leao AA: Further observations on the spreading depression of activity in the cerebral cortex. J Neurophysiol 10:409\u2013414, 194710.1152\/jn.1947.10.6.40920268874"},{"key":"b14-jns151871","series-title":"Brain","doi-asserted-by":"publisher","first-page":"1994","DOI":"10.1093\/brain\/awq117","article-title":"Spreading depolarizations cycle around and enlarge focal ischaemic brain lesions","volume":"133","author":"Nakamura H,","year":"2010","unstructured":"Nakamura H, Strong AJ, Dohmen C, Sakowitz OW, Vollmar S, Su\u00e9 M, : Spreading depolarizations cycle around and enlarge focal ischaemic brain lesions. Brain 133:1994\u20132006, 201010.1093\/brain\/awq11720504874"},{"key":"b15-jns151871","series-title":"Ann Neurol","doi-asserted-by":"publisher","first-page":"344","DOI":"10.1002\/ana.410090406","article-title":"Focal hyperemia followed by spreading oligemia and impaired activation of rCBF in classic migraine","volume":"9","author":"Olesen J,","year":"1981","unstructured":"Olesen J, Larsen B, Lauritzen M: Focal hyperemia followed by spreading oligemia and impaired activation of rCBF in classic migraine. Ann Neurol 9:344\u2013352, 1981678466410.1002\/ana.410090406"},{"key":"b16-jns151871","series-title":"Stroke","doi-asserted-by":"publisher","first-page":"2738","DOI":"10.1161\/01.STR.0000043073.69602.09","article-title":"Spreading and synchronous depressions of cortical activity in acutely injured human brain","volume":"33","author":"Strong AJ,","year":"2002","unstructured":"Strong AJ, Fabricius M, Boutelle MG, Hibbins SJ, Hopwood SE, Jones R, : Spreading and synchronous depressions of cortical activity in acutely injured human brain. Stroke 33:2738\u20132743, 20021246876310.1161\/01.STR.0000043073.69602.09"},{"key":"b17-jns151871","series-title":"Curr Opin Crit Care","doi-asserted-by":"publisher","first-page":"126","DOI":"10.1097\/MCC.0b013e32807faffb","article-title":"Cortical spreading depression: an adverse but treatable factor in intensive care?","volume":"13","author":"Strong AJ,","year":"2007","unstructured":"Strong AJ, Hartings JA, Dreier JP: Cortical spreading depression: an adverse but treatable factor in intensive care?. Curr Opin Crit Care 13:126\u2013133, 20071732773210.1097\/MCC.0b013e32807faffb"},{"key":"b18-jns151871","series-title":"Neurology","doi-asserted-by":"publisher","first-page":"1095","DOI":"10.1212\/WNL.0b013e3182886932","article-title":"Propagation of cortical spreading depolarization in the human cortex after malignant stroke","volume":"80","author":"Woitzik J,","year":"2013","unstructured":"Woitzik J, Hecht N, Pinczolits A, Sandow N, Major S, Winkler MK, : Propagation of cortical spreading depolarization in the human cortex after malignant stroke. Neurology 80:1095\u20131102, 20132344668310.1212\/WNL.0b013e3182886932"}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/126\/1\/article-p266.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/126\/1\/article-p266.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/126\/1\/article-p266.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,23]],"date-time":"2025-03-23T03:14:54Z","timestamp":1742699694000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/126\/1\/article-p266.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,1]]},"references-count":18,"journal-issue":{"issue":"1"},"URL":"https:\/\/doi.org\/10.3171\/2015.11.jns151871","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,1]]}}}