Skip to main content Accessibility help
×
Hostname: page-component-78c5997874-s2hrs Total loading time: 0 Render date: 2024-11-10T08:25:47.804Z Has data issue: false hasContentIssue false

Chapter 18 - Invasive Investigation of Insular Epilepsy: Surgical Techniques

from Section 4 - Invasive Investigation of Insular Epilepsy

Published online by Cambridge University Press:  09 June 2022

Dang Nguyen
Affiliation:
Université de Montréal
Jean Isnard
Affiliation:
Claude Bernard University Lyon
Philippe Kahane
Affiliation:
Grenoble-Alpes University Hospital
Get access

Summary

Approximately 70% of patients with insular epilepsy require invasive investigation prior to resective or ablative surgery. Two broad techniques can be employed to invasively sample the insula and insular epileptogenic network. The first and most commonly used technique, stereo-electroencephalography (SEEG), involves the placement of intracerebral electrodes through drill-holes under stereotactic conditions (with or without robotic assistance) in the insula and relevant peri-insular network targets. The open technique involves the placement of depth electrodes within the insular cortex following the opening of the Sylvian fissure, in addition to peri-Sylvian grids over the cortical convexities or strips over the fronto-temporal-basal lobes/interhemispheric space. While there are no guidelines to decide which method to resort to, there are relative advantages, disadvantages, and scenarios where each may be beneficial. The vast majority of centers favor the SEEG technique, as it is minimally invasive, is associated with the lowest morbidity, and is particular adapted for investigating insular epileptic networks that usually involve widespread multi-lobar anatomical sites and deep structures (e.g., cingulate, mesial temporal structures, etc.). SEEG is also well-suited for bilateral cases and cases that involve reoperations, both of which are not infrequent in insular epilepsy. Finally, SEEG is an appealing option in patients in whom minimally invasive ablation (laser ablation or radiofrequency ablation) is being considered. In SEEG, insular electrodes can be placed through a trans-opercular orthogonal approach and/or through an oblique parasagittal approach (trans-frontally and/or trans-parietally). The open technique, on the other hand, is particularly suited for patients with superficial lesional epilepsy in whom the epileptogenic zone is clearly unilateral but requires invasive functional mapping, such as dominant hemisphere temporal lobe epilepsy with suspected insular involvement.

Type
Chapter
Information
Insular Epilepsies , pp. 211 - 226
Publisher: Cambridge University Press
Print publication year: 2022

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Guillaume, M. and Mazars, G., “Technique de résection de l’insula dans les épilepsies insulaires,” Rev Neurol, vol. 81, pp. 900903, 1949.Google Scholar
Guillaume, M. and Mazars, G., “Cinq cas de foyers épileptogènes insulaires opérés,” Soc Française Neurol, pp. 766–769, 1949.Google Scholar
Penfield, W. and Faulk, M., “The insula: further observations on its function,” Brain, vol. 78, pp. 445470, 1955.CrossRefGoogle ScholarPubMed
Guillaume, M., Mazars, G., and Mazars, Y., “Indications chirurgicales dans les épilepsies dites ‘temporalis,’” Rev Neurol, vol. 88, pp. 461501, 1953.Google Scholar
Silfvenius, H., Gloor, P., and Rasmussen, T., “Evaluation of insular ablation in surgical treatment of temporal lobe epilepsy,” Epilepsia, vol. 5, pp. 307320, 1964.Google Scholar
Isnard, J., Guénot, M., Sindou, M., and Mauguière, F., “Clinical manifestations of insular lobe seizures: A stereo-electroencephalographic study,” Epilepsia, vol. 45, no. 9, pp. 10791090, 2004.CrossRefGoogle ScholarPubMed
Talairach, J. and Bancaud, J., “Methodology of anatomo-functional stereotaxic investigations,” Prog Neurol Surg, vol. 5, pp. 297354, 1973.CrossRefGoogle Scholar
Guenot, M. et al., “The Talairach SEEG method. Stereoelectroencephalography. Indications, results, complications and therapeutic applications in a series of 100 consecutive cases,” Stereotact Funct Neurosurg, vol. 77, pp. 2932, 2001.CrossRefGoogle Scholar
Cossu, M. et al., “Stereoelectroencephalography in the presurgical evaluation of focal epilepsy: A retrospective analysis of 215 procedures,” Neurosurgery, vol. 57, no. 4, pp. 706718, 2005.CrossRefGoogle ScholarPubMed
Isnard, J., Guénot, M., Ostrowsky, K., Sindou, M., and Mauguière, F., “The role of the insular cortex in lobe epilepsy,” Ann Neurol, vol. 48, no. 4, pp. 614623, 2000.3.0.CO;2-S>CrossRefGoogle ScholarPubMed
Tanriover, N., Rhoton, A. L., Kawashima, M., Ulm, A. J., and Yasuda, A., “Microsurgical anatomy of the insula and the Sylvian fissure,” J Neurosurg, vol. 100, no. 5, pp. 891922, 2004.CrossRefGoogle ScholarPubMed
Zerouali, Y., Ghaziri, J., and Nguyen, D. K., Multimodal investigation of epileptic networks: The case of insular cortex epilepsy, 1st ed, vol. 226. Elsevier B.V., 2016.Google Scholar
Jobst, B. C. et al., “The Insula and Its Epilepsies,” Epilepsy Curr, vol. 19, no. 1, pp. 1121, 2019.Google Scholar
Laoprasert, P., Ojemann, J. G., and Handler, M. H., “Insular epilepsy surgery,” Epilepsia, vol. 58, pp. 3545, 2017.Google Scholar
Surbeck, W. et al., “The combination of subdural and depth electrodes for intracranial EEG investigation of suspected insular (peri-Sylvian) epilepsy,” Epilepsia, vol. 52, no. 3, pp. 458466, 2011.CrossRefGoogle Scholar
Park, Y. S. et al., “Insular epilepsy surgery under neuronavigation guidance using depth electrode,” Child’s Nerv Syst, vol. 25, no. 5, pp. 591597, 2009.Google Scholar
Weil, A. G., Fallah, A., Lewis, E. C., and Bhatia, S., “Medically resistant pediatric insular-opercular/peri-Sylvian epilepsy. Part 1: Invasive monitoring using the parasagittal transinsular apex depth electrode,” J Neurosurg Pediatr, vol. 18, no. 5, pp. 511522, 2016.CrossRefGoogle Scholar
Hale, A. T. et al., “Open resection versus laser interstitial thermal therapy for the treatment of pediatric insular epilepsy,” Clin Neurosurg, vol. 85, no. 4, pp. E730–E736, 2019.CrossRefGoogle ScholarPubMed
Perry, M. S. et al., “Magnetic resonance imaging guided laser interstitial thermal therapy as treatment for intractable insular epilepsy in children,” J Neurosurg Pediatr, vol. 20, no. 6, pp. 575582, 2017.CrossRefGoogle ScholarPubMed
Catenoix, H., Mauguière, F., Montavont, A., Ryvlin, P., Guénot, M., and Isnard, J., “Seizures outcome after stereoelectroencephalography-guided thermocoagulations in malformations of cortical development poorly accessible to surgical resection,” Neurosurgery, vol. 77, no. 1, pp. 914, 2015.CrossRefGoogle ScholarPubMed
Mullatti, N. et al., “Stereotactic thermocoagulation for insular epilepsy: Lessons from successes and failures,” Epilepsia, vol. 60, no. 8, pp. 15651579, 2019.CrossRefGoogle ScholarPubMed
Ahmed, R. et al., “Diagnostic evaluation and surgical management of pediatric insular epilepsy utilizing magnetoencephalography and invasive EEG monitoring,” Epilepsy Res, vol. 140, December 2017, pp. 7281, 2018.CrossRefGoogle ScholarPubMed
Ryvlin, P. and Kahane, P., “The hidden causes of surgery-resistant temporal lobe epilepsy: Extratemporal or temporal plus?,” Curr Opin Neurol, vol. 18, no. 2, pp. 125127, 2005.Google Scholar
Cardinale, F., “Letter to the editor: Stereoelectroencephalography for insular-opercular/peri-Sylvian epilepsy,” J Neurosurg Pediatr, vol. 19, no. 2, pp. 271272, 2017.Google Scholar
Isnard, J. et al., “French guidelines on stereoelectroencephalography (SEEG),” Neurophysiol Clin, vol. 48, no. 1, pp. 513, 2018.CrossRefGoogle ScholarPubMed
Tandon, N. et al., “Analysis of morbidity and outcomes associated with use of subdural grids vs. stereoelectroencephalography in patients with intractable epilepsy,” JAMA Neurol, vol. 76, no. 6, pp. 672681, 2019.CrossRefGoogle ScholarPubMed
Yan, H. et al., “Method of invasive monitoring in epilepsy surgery and seizure freedom and morbidity: A systematic review,” Epilepsia, vol. 60, no. 9, pp. 19601972, 2019.CrossRefGoogle ScholarPubMed
Hader, W. J. et al., “Complications of epilepsy surgery – A systematic review of focal surgical resections and invasive EEG monitoring,” Epilepsia, vol. 54, no. 5, pp. 840847, 2013.Google Scholar
Mullin, J. P. et al., “Is SEEG safe? A systematic review and meta-analysis of stereo-electroencephalography-related complications,” Epilepsia, vol. 57, no. 3, pp. 386401, 2016.Google Scholar
Cardinale, F. et al., “Stereoelectroencephalography: Surgical methodology, safety, and stereotactic application accuracy in 500 procedures,” Neurosurgery, vol. 72, no. 3, pp. 353366, 2013.Google Scholar
Cardinale, F. et al., “Cerebral angiography for multimodal surgical planning in epilepsy surgery: Description of a new three-dimensional technique and literature review,” World Neurosurg, vol. 84, no. 2, pp. 358367, 2015.Google Scholar
Cardinale, F. et al., “Stereoelectroencephalography: Retrospective analysis of 742 procedures in a single centre,” Brain, vol. 142, no. 9, pp. 26882704, 2019.CrossRefGoogle ScholarPubMed
Cossu, M. et al., “Stereoelectroencephalography-guided radiofrequency thermocoagulation in the epileptogenic zone: A retrospective study on 89 cases,” J Neurosurg, vol. 123, no. 6, pp. 13581367, 2015.Google Scholar
Alomar, S., Mullin, J. P., Smithason, S., and Gonzalez-Martinez, J., “Indications, technique, and safety profile of insular stereoelectroencephalography electrode implantation in medically intractable epilepsy,” J Neurosurg, vol. 128, no. 4, pp. 11471157, 2018.Google Scholar
Bouthillier, A., Weil, A. G., Martineau, L., Letourneau-Guillon, L., and Nguyen, D., “Operculoinsular cortectomy for refractory epilepsy. Part 2: Is it safe?,” J Neurosurg, vol. 20, pp. 111, 2019.Google Scholar
Ikegaya, N. et al., “Surgical strategy to avoid ischemic complications of the pyramidal tract in resective epilepsy surgery of the insula: Technical case report,” J Neurosurg, vol. 128, no. 4, pp. 11731177, 2018.Google Scholar
Nguyen, D. K. et al., “Revisiting the role of the insula in refractory partial epilepsy,” Epilepsia, vol. 50, no. 3, pp. 510520, 2009.CrossRefGoogle ScholarPubMed
Tomycz, L. D., Hale, A. T., Haider, A. S., Clarke, D. F., and Lee, M. R., “Invasive insular sampling in pediatric epilepsy: A single-institution experience,” Oper Neurosurg, vol. 15, no. 3, pp. 310317, 2018.CrossRefGoogle ScholarPubMed
Robles, S., Gelisse, P., El Fertit, H., Tancu, C., H. Duffau, and A. Crespel, “Parasagittal transinsular electrodes for stereo- EEG in temporal and insular lobe epilepsies,” Stereotact Funct Neurosurg, vol. 87, pp. 368378, 2009.CrossRefGoogle ScholarPubMed
Afif, A., “Safety and usefulness of insular depth electrodes implanted via an oblique approach in patients with epilepsy,” Neurosurgery, vol. 62, no. 5, 2008.Google ScholarPubMed
Chassoux, F., Navarro, V., Catenoix, H., Valton, L., and Vignal, J., “Planning and management of SEEG,” Neurophysiol Clin Neurophysiol, vol. 45, pp. 2537, 2018.Google Scholar
Weil, A. G. et al., “Medically resistant pediatric insular-opercular/peri-Sylvian epilepsy. Part 2: Outcome following resective surgery,” J Neurosurg Pediatr, vol. 18, no. 5, pp. 523535, 2016.Google Scholar
Bouthillier, A., Weil, A. G., Martineau, L., Létourneau-Guillon, L., and Nguyen, D. K., “Operculoinsular cortectomy for refractory epilepsy. Part 1: Is it effective?,” J Neurosurg, 2020;133:950–959Google Scholar
Cardinale, F., Casaceli, G., Raneri, F., Miller, J., and Lo Russo, G., “Implantation of stereoelectroencephalography electrodes: A systematic review,” J Clin Neurophysiol, vol. 33, no. 6, pp. 490502, 2016.CrossRefGoogle ScholarPubMed
Bourdillon, P. et al., “Stereotactic electroencephalography is a safe procedure, including for insular implantations,” World Neurosurg, vol. 99, pp. 353361, 2017.Google Scholar
Cardinale, F., “Commentary: Incorporating new technology into a surgical technique: The learning curve of a single surgeon’s stereo-electroencephalography experience,” Neurosurgery, vol. 86, no. 3, pp. E290E291, 2020.Google Scholar
Bourdillon, P. et al., “Effective accuracy of stereoelectroencephalography: robotic 3D versus Talairach orthogonal approaches,” J Neurosurg, 2019;131:1938–1946.Google Scholar
Cardinale, F. et al., “A new tool for touch-free patient registration for robot-assisted intracranial surgery: Application accuracy from a phantom study and a retrospective surgical series,” Neurosurg Focus, vol. 42, no. 5, pp. 17, 2017.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×