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The insular cortex is an extensively connected brain region that has recently gained considerable interest due to its elusive role in several pathological conditions and its involvement in a variety of functions. Structural connectivity studies have identified connections to the frontal, temporal, and parietal cortices, with both a rostro-caudal and a dorso-ventral organizational pattern. The insula is also widely connected to subcortical structures. The use of diffusion-weighted imaging in insular epilepsy has not yet reached its full potential; however, it may still provide some insights into its pathophysiology, assess long-term consequences, and help prevent operative complications. This chapter explores the insula’s structural connectivity and promising applications in the field of insular epilepsy.
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