Safety of an operculoinsulectomy in the language-dominant hemisphere for refractory epilepsy

Karatepe, Hazal Melek; Safi, Dima; Martineau, Laurence; Boucher, Olivier; Nguyen, Dang Khoa; Bouthillier, Alain

doi:10.1016/j.clineuro.2021.107014

Cited by 2 publications

(3 citation statements)

References 24 publications

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“…75 If the lesion affects the dominant hemisphere, a language deficit may occur, 14,75 which is temporary in most cases. 88,89 Putamen and internal capsule are close to the posterior insula and intraoperative electrical stimulation is useful to search for a motor response in this area. 75 Nevertheless, a transopercular subpial dissection respecting the arachnoidal-pial layer without the sylvian fissure and avoiding vessel coagulations is possible.…”

Section: Insular Resectionmentioning

confidence: 99%

“…In the case of the frontoparietal operculum, a hemifacial sensory‐motor deficit, generally transient, may occur 75 . If the lesion affects the dominant hemisphere, a language deficit may occur, 14,75 which is temporary in most cases 88,89 . Putamen and internal capsule are close to the posterior insula and intraoperative electrical stimulation is useful to search for a motor response in this area 75 .…”

Section: Therapeutic Approaches To Insular Epilepsymentioning

confidence: 99%

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Diagnostic and therapeutic approaches in refractory insular epilepsy

et al. 2023

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Due to heterogenous seizure semiology and poor contribution of scalp electroencephalography (EEG) signals, insular epilepsy requires use of the appropriate diagnostic tools for its diagnosis and characterization. The deep location of the insula also presents surgical challenges. The aim of this article is to review the current diagnostic and therapeutic tools and their contribution to the management of insular epilepsy. Magnetic resonance imaging (MRI), isotopic imaging, neurophysiological imaging, and genetic testing should be used and interpretated with caution. Isotopic imaging and scalp EEG have demonstrated a lower value in epilepsy from insular compared to temporal origin, which increases the interest of functional MRI and magnetoencephalography. Intracranial recording with stereoelectroencephalography (SEEG) is often required. The insular cortex, being highly connected and deeply located under highly functional areas, is difficult to reach, and its ablative surgery raises functional issues. Tailored resection based on SEEG or alternative curative treatments, such as radiofrequency thermocoagulation, laser interstitial thermal therapy, or stereotactic radiosurgery, have produced encouraging results. The management of insular epilepsy has benefited from major advances in the last years. Perspectives for diagnostic and therapeutic procedures will contribute to better management of this complex form of epilepsy.

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Section: Insular Resectionmentioning

confidence: 99%

Section: Therapeutic Approaches To Insular Epilepsymentioning

confidence: 99%

Diagnostic and therapeutic approaches in refractory insular epilepsy

et al. 2023

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“…A recent review has reported that in well characterized insular epilepsies, seizure-freedom can be achieved in more than 70% of patients after resection [30]. Nevertheless, the morbidity associated with insular resection may be high, as a recent case series has shown that up to 46% of patients undergoing dominant operculoinsulectomies have transient postoperative aphasia, with complete recovery during their long-term follow-up [31 ▪▪ ]. Our group has implemented the use of robotically placed insular depth electrodes for identifying the region of epileptogenesis and then guide the subsequent resection (Fig.…”

Section: Recent Innovations In Surgical Techniquesmentioning

confidence: 99%

Recent advances in epilepsy surgery

Medina-Pizarro

Spencer²,

Damisah³

2023

Current Opinion in Neurology

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Purpose of reviewTechnological innovations in the preoperative evaluation, surgical techniques and outcome prediction in epilepsy surgery have grown exponentially over the last decade. This review highlights and emphasizes relevant updates in techniques and diagnostic tools, discussing their context within standard practice at comprehensive epilepsy centres. Recent findingsHigh-resolution structural imaging has set an unprecedented opportunity to detect previously unrecognized subtle abnormalities. Machine learning and computer science are impacting the methodologies to analyse presurgical and surgical outcome data, building more accurate prediction models to tailor treatment strategies. Robotic-assisted placement of depth electrodes has increased the safety and ability to sample epileptogenic nodes within deep structures, improving our understanding of the seizure networks in drugresistant epilepsy. The current available minimally invasive techniques are reasonable surgical alternatives to ablate or disrupt epileptogenic regions, although their sustained efficacy is still an active area of research.

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Safety of an operculoinsulectomy in the language-dominant hemisphere for refractory epilepsy

Cited by 2 publications

References 24 publications

Diagnostic and therapeutic approaches in refractory insular epilepsy

Diagnostic and therapeutic approaches in refractory insular epilepsy

Recent advances in epilepsy surgery

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