Stereotactic thermocoagulation for insular epilepsy: Lessons from successes and failures

Mullatti, Nandini; Landré, Elisabeth; Mellerio, Charles; Oliveira, Andréa J.; Laurent, Agathe; Turak, B.; Devaux, Bertrand; Chassoux, Francine

doi:10.1111/epi.16092

Cited by 34 publications

(41 citation statements)

References 47 publications

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“…14,16,35,36,[44][45][46] Despite focal onset, RFTC did not lead to sustained seizure freedom, similar to previous studies 47 ; however, volume-based insula thermocoagulation as a second procedure following SEEG has shown good results. 48 Five patients were not operated, 4 of whom had dominant insula EZ, where resection was not recommended due to risk of complications. Due to morbidity associated with resections of the most caudal-rostral insular cortex, alternative treatment approaches including neuromodulation with responsive neurostimulation (RNS), DBS, and focal laser ablation have been considered.…”

Section: Insular Tailored Surgery Can Be Focalmentioning

confidence: 99%

Mapping the Insula with Stereo‐Electroencephalography: The Emergence of Semiology in Insula Lobe Seizures

Singh

Príncipe

Tadel

et al. 2020

Annals of Neurology

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Objective Insula epilepsy is rare and can be evaluated effectively by Stereotactic intracerebral EEG (SEEG). Many previous studies of insulo‐opercular seizures have been unable to separate insular and opercular onset. With adequate sampling of the insula, this study shows this is possible. Methods We analyzed intrainsular dynamics and extrainsular propagation in 12 patients with “pure” insula epilepsy (n = 9) or insular and only deepest opercular involvement (n = 3) at seizure onset. Review of semiology defined clinical groups, agglomerative cluster, and principal component analysis of semiological features were performed. Quantitative epileptogenicity, and intrainsular and extrainsular propagation were computed via time frequency analysis and epileptogenicity mapping. Results Seizure onset patterns were heterogeneous; the seizure onset zone was focal. Seizure onset and first ictal change within insula functional subdivision correlated with aura and reflex component. No paninsular spread occurred; contralateral insular spread was very early. While the discharge was intrainsular, clinical signs related to aura or vegetative signs. Extrainsular propagation was early and related to the emergence of the majority of clinical signs. Cluster analysis found an anterior, intermediate, and posterior insula seizure onset group. The largest principal component separated anterior insula manifestations, including early hypermotor signs, early recovery, and no aura from posterior insula features of early dystonia, early tonic motor features, and sensorimotor aura. Interpretation Aura is vital to identifying seizure onset and relates to insula functional subdivision. Seizures are heterogenous; extrainsular propagation occurs early, accounting for most of the semiology. With adequate sampling, "pure" insula epilepsy can be identified and focal curative resection is possible. ANN NEUROL 2020;88:477–488

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Section: Insular Tailored Surgery Can Be Focalmentioning

confidence: 99%

Mapping the Insula with Stereo‐Electroencephalography: The Emergence of Semiology in Insula Lobe Seizures

Singh

Príncipe

Tadel

et al. 2020

Annals of Neurology

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“…Two patients had beneficial effects from the procedure ( 71 ). In the biggest insular RFTC-dedicated series published by Saint Anne's group (Paris), 89% of their 19 patients were good responders with 10 Engels's class I, 4 class II, and 3 class III patients ( 72 ). RFTC was performed as a separate procedure after SEEG.…”

Section: Indications For Insular Seegmentioning

confidence: 99%

Indications, Techniques, and Outcomes of Robot-Assisted Insular Stereo-Electro-Encephalography: A Review

et al. 2020

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Stereo-electro-encephalography (SEEG) is an invasive, surgical, and electrophysiological method for three-dimensional registration and mapping of seizure activity in drug-resistant epilepsy. It allows the accurate analysis of spatio-temporal seizure activity by multiple intraparenchymal depth electrodes. The technique requires rigorous non-invasive pre-SEEG evaluation (clinical, video-EEG, and neuroimaging investigations) in order to plan the insertion of the SEEG electrodes with minimal risk and maximal recording accuracy. The resulting recordings are used to precisely define the surgical limits of resection of the epileptogenic zone in relation to adjacent eloquent structures. Since the initial description of the technique by Talairach and Bancaud in the 1950's, several techniques of electrode insertion have been used with accuracy and relatively few complications. In the last decade, robot-assisted surgery has emerged as a safe, accurate, and time-saving electrode insertion technique due to its unparalleled potential for orthogonal and oblique insertion trajectories, guided by rigorous computer-assisted planning. SEEG exploration of the insular cortex remains difficult due to its anatomical location, hidden by the temporal and frontoparietal opercula. Furthermore, the close vicinity of Sylvian vessels makes surgical electrode insertion challenging. Some epilepsy surgery teams remain cautious about insular exploration due to the potential of neurovascular injury. However, several authors have published encouraging results regarding the technique's accuracy and safety in both children and adults. We will review the indications, techniques, and outcomes of insular SEEG exploration with emphasis on robot-assisted implantation.

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“…However, since their first descriptions, a main difficulty in achieving an overview of the spectrum of clinical semiology has been lack of large published series, previous studies having included as few 6 patients 5 and the largest series to date being based on 22 patients 11 5,12 do not investigate semiologic features, 11,13,14 or do not focus on spontaneous seizures 15,16 . In addition, previous studies have not addressed the potential role of specific insulo‐opercular functional subregions in different semiologic and propagation patterns.…”

Section: Introductionmentioning

confidence: 99%

Semiologic subgroups of insulo‐opercular seizures based on connectional architecture atlas

et al. 2020

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Objective: Insulo-opercular seizures are characterized by diverse semiology, related to the insula's multiple functional roles and extensive connectivity. We aimed to identify semiologic subgroups and correlate these with insulo-opercular subregions based on connectional architecture. Methods: We retrospectively collected a large series of 37 patients with insuloopercular seizures explored by stereoelectroencephalography (SEEG) from three epilepsy centers. A new human brain atlas (Brainnetome Atlas, BNA) based on both anatomic and functional connections was employed to segment insulo-opercular cortex. Semiology and SEEG changes were carefully reviewed and quantified. Principal component analysis and cluster analysis were used to correlate semiologic characteristics with insulo-opercular subregions. Results: Four main semiologic subgroups were identified, organized along an anteroventral to posterodorsal axis based on BNA. Group 1 was characterized by epigastric sensation and/or integrated gestural motor behaviors with or without feelings of fear or rage, involving the anteroventral insular regions and mesial temporal lobes. Group 2 was characterized by auditory sensations and symmetric proximal/axial tonic signs involving the posteroventral temporal operculum. The characteristics of group 3 were orofacial and laryngeal signs, involving the intermediate insulo-opercular regions.The features of group 4 were somatosensory signs followed by nonintegrated gestural motor behaviors and/or asymmetric tonic signs involving the posterodorsal insuloopercular regions with propagation to the mesial frontal lobes. Thus anteroventral seizure organizations predominantly showed limbic system semiology, whereas more posterodorsal regions were associated with semiology involving mainly the sensorimotor system. Subjective symptoms proved to be particularly discriminating factors. Significance: Insulo-opercular seizures can be categorized in terms of clinical semiology and correlate with connectional architecture subregions along an anteroventral-posterodorsal axis in line with the cytoarchitectonic gradient rather than the gyral anatomy [Corrections added on May 13, 2020, after first online publication: Affiliations of authors "Xiu Wang" and "Xiao Wang" were changed from 5 and 6 to 4 and 5.] | 985 WANG et Al.

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Stereotactic thermocoagulation for insular epilepsy: Lessons from successes and failures

Cited by 34 publications

References 47 publications

Mapping the Insula with Stereo‐Electroencephalography: The Emergence of Semiology in Insula Lobe Seizures

Mapping the Insula with Stereo‐Electroencephalography: The Emergence of Semiology in Insula Lobe Seizures

Indications, Techniques, and Outcomes of Robot-Assisted Insular Stereo-Electro-Encephalography: A Review

Semiologic subgroups of insulo‐opercular seizures based on connectional architecture atlas

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