Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-77c89778f8-n9wrp Total loading time: 0 Render date: 2024-07-20T22:09:02.027Z Has data issue: false hasContentIssue false

Chapter 22 - Insular Epilepsy Surgery: Surgical Techniques and Experience of Various Centers

from Section 5 - Surgical Management of Insular Epilepsy

Published online by Cambridge University Press:  09 June 2022

By
Alain Bouthillier ,
Stephan Chabardes ,
Massimo Cossu  and
Jorge Gonzalez-Martinez
Edited by
Dang Nguyen ,
Jean Isnard  and
Philippe Kahane
Dang Nguyen
Affiliation:
Université de Montréal
Jean Isnard
Affiliation:
Claude Bernard University Lyon
Philippe Kahane
Affiliation:
Grenoble-Alpes University Hospital
Get access

Summary

Refractory epilepsy from operculoinsular origin is increasingly recognized because of published descriptions of its clinical presentations, more attention in the interpretation of non-invasive focus localization techniques, and the development of invasive electrode implantation schemes to sample that area. Microsurgical techniques of operculo-insular cortical resection have been refined, taking into consideration the complex and deep anatomy and the high vascularity of the perisylvian area. Selective transsylvian and/or subpial transopercular insulectomies are performed, depending on the definition of the extent of cortectomy needed and the functional areas to preserve. Seizure control results after surgery are similar than those in other brain locations. Neurological complications and neuropsychological consequences are acceptable. It is crucial that these highly selected patients be investigated and operated in epilepsy centers dedicated to this complex type of refractory epilepsy, both to optimize the results of seizure control and keep the complication rate as low as possible.

Keywords

insular surgeryinsulectomyoperculoinsulectomysurgical complications
Type
Chapter
Information
Insular Epilepsies , pp. 257 - 265
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

Penfield, W, Faulk, ME, Jr. The insula: Further observations on its function. Brain. 1955;78(4):445–470.CrossRefGoogle ScholarPubMed
Guillaume, J, Mazars, G. Technique de résection de l’insula dans les épilepsies insulaires. Revue Neurologie. 1949;81:900–903.Google Scholar
Afif, A, Chabardes, S, Minotti, L, Kahane, P, Hoffmann, D. Safety and usefulness of insular depth electrodes implanted via an oblique approach in patients with epilepsy. Neurosurgery. 2008;62(5 suppl 2):ONS471-9; discussion 9–80.Google Scholar
Ahmed, R, Otsubo, H, Snead, C III, Donner, E, Widjaja, E, Ochi, A, et al. Diagnostic evaluation and surgical management of pediatric insular epilepsy utilizing magnetoencephalography and invasive EEG monitoring. Epilepsy Res. 2018;140:72–81.Google Scholar
Bouthillier, A, Surbeck, W, Weil, AG, Tayah, T, Nguyen, DK. The hybrid operculo-insular electrode: a new electrode for intracranial investigation of peri-Sylvian/insular refractory epilepsy. Neurosurgery. 2012;70(6):1574–1580; discussion 80.Google Scholar
Gras-Combe, G, Minotti, L, Hoffmann, D, Krainik, A, Kahane, P, Chabardes, S. Surgery for nontumoral insular epilepsy explored by stereoelectroencephalography. Neurosurgery. 2016;79(4):578–588.Google Scholar
Isnard, J, Guenot, M, Sindou, M, Mauguiere, F. Clinical manifestations of insular lobe seizures: A stereo-electroencephalographic study. Epilepsia. 2004;45(9):1079–1090.Google Scholar
Levy, A, Tran Phuoc, Y, Boucher, O, Bouthillier, A, Nguyen, DK. Operculo-insular epilepsy: Scalp and intracranial electroencephalographic findings. Journal of Clinical Neurophysiology. 2017.Google Scholar
Mohamed, IS, Bouthillier, A, Berube, A, Cossette, P, Finet, P, Saint-Hilaire, JM, et al. The clinical impact of integration of magnetoencephalography in the presurgical workup for refractory nonlesional epilepsy. Epilepsy Behav. 2018;79:34–41.Google Scholar
Nguyen, DK, Nguyen, DB, Malak, R, Leroux, JM, Carmant, L, Saint-Hilaire, JM, et al. Revisiting the role of the insula in refractory partial epilepsy. Epilepsia. 2009;50(3):510–520.Google Scholar
Surbeck, W, Bouthillier, A, Weil, AG, Crevier, L, Carmant, L, Lortie, A, et al. The combination of subdural and depth electrodes for intracranial EEG investigation of suspected insular (perisylvian) epilepsy. Epilepsia. 2011;52(3):458–466.Google Scholar
Malak, R, Bouthillier, A, Carmant, L, Cossette, P, Giard, N, Saint-Hilaire, JM, et al. Microsurgery of epileptic foci in the insular region. Journal of Neurosurgery. 2009;110(6):1153–1163.Google Scholar
Silfvenius, H, Gloor, P, Rasmussen, T. Evaluation of insular ablation in surgical treatment of temporal lobe epilepsy. Epilepsia. 1964;5:307–20.Google Scholar
Yasargil, M, Krisht, A, Türe, U, Al-Mefty, O, Yasargil, D. Microsurgery of insular gliomas. Part VI: Surgical treatment and outcome. Contemporary Neurosurg 2002;24:1–8.Google Scholar
Duffau, H. A personal consecutive series of surgically treated 51 cases of insular WHO Grade II glioma: advances and limitations. J Neurosurg. 2009;110(4):696–708.Google Scholar
Duffau, H, Capelle, L, Lopes, M, Bitar, A, Sichez, JP, van Effenterre, R. Medically intractable epilepsy from insular low-grade gliomas: improvement after an extended lesionectomy. Acta Neurochir (Wien). 2002;144(6):563–572; discussion 72–73.Google Scholar
Sanai, N, Polley, MY, Berger, MS. Insular glioma resection: Assessment of patient morbidity, survival, and tumor progression. J Neurosurg. 2010;112(1):1–9.CrossRefGoogle ScholarPubMed
Bouthillier, A, Nguyen, DK. Epilepsy surgeries requiring an operculoinsular cortectomy: operative technique and results. Neurosurgery. 2017.Google Scholar
Park, YS, Lee, YH, Shim, KW, Lee, YJ, Kim, HD, Lee, JS, et al. Insular epilepsy surgery under neuronavigation guidance using depth electrode. Childs Nerv Syst. 2009;25(5):591–597.Google Scholar
Jobst, BC, Gonzalez-Martinez, J, Isnard, J, Kahane, P, Lacuey, N, Lahtoo, SD, et al. The insula and its epilepsies. Epilepsy Curr. 2019;19(1):11–21.Google Scholar
Finet, P, Nguyen, DK, Bouthillier, A. Vascular consequences of operculoinsular corticectomy for refractory epilepsy. J Neurosurg. 2015;122(6):1293–1298.Google Scholar
Lazorthes, G. Vascularisation et circulation cérébrales. Masson & Cie; 1961.Google Scholar
Ture, U, Yasargil, DC, Al-Mefty, O, Yasargil, MG. Topographic anatomy of the insular region. J Neurosurg. 1999;90(4):720–733.CrossRefGoogle ScholarPubMed
Ture, U, Yasargil, MG, Al-Mefty, O, Yasargil, DC. Arteries of the insula. J Neurosurg. 2000;92(4):676–687.Google Scholar
Bouthillier, A, Weil, AG, Martineau, L, Létourneau-Guillon, L, Nguyen DK. Operculoinsular cortectomy for refractory epilepsy. Part II: Is-it safe ? J Neurosurg. 2019; DOI: 10.3171/2019.6.JNS191126.Google Scholar
Ackermann, H, Riecker, A. The contribution(s) of the insula to speech production: a review of the clinical and functional imaging literature. Brain Struct Funct. 2010;214(5–6):419–433.Google Scholar
Ansari, SF, Maher, CO, Tubbs, RS, Terry, CL, Cohen-Gadol, AA. Surgery for extratemporal nonlesional epilepsy in children: A meta-analysis. Childs Nerv Syst. 2010;26(7):945–951.Google Scholar
Ansari, SF, Tubbs, RS, Terry, CL, Cohen-Gadol, AA. Surgery for extratemporal nonlesional epilepsy in adults: an outcome meta-analysis. Acta Neurochir (Wien). 2010;152(8):1299–1305.Google Scholar
Tellez-Zenteno, JF, Dhar, R, Wiebe, S. Long-term seizure outcomes following epilepsy surgery: A systematic review and meta-analysis. Brain. 2005;128(pt 5):1188–1198.Google Scholar
Wiebe, S, Blume, WT, Girvin, JP, Eliasziw, M, Effectiveness, efficiency of surgery for temporal lobe epilepsy study G. A randomized, controlled trial of surgery for temporal-lobe epilepsy. N Engl J Med. 2001;345(5):311–318.CrossRefGoogle Scholar
Bouthillier, A, Weil, AG, Martineau, L, Létourneau-Guillon, L, Nguyen DK. Operculoinsular cortectomy for refractory epilepsy. Part I: Is-it effective? J Neurosurg. 2019. DOI: 10.3171/2019.4.JNS1912.Google Scholar
Fei, P, Soucy, J-P, Obaid, S, Boucher, O, Bouthillier, A, Nguyen, DK. The value of rCBF SPECT and FDG PET in operculo-insular epilepsy. Clinical Nuclear Imaging. 2017.Google Scholar
Mohamed, IS, Gibbs, SA, Robert, M, Bouthillier, A, Leroux, JM, Khoa Nguyen, D. The utility of magnetoencephalography in the presurgical evaluation of refractory insular epilepsy. Epilepsia. 2013;54(11):1950–1959.CrossRefGoogle ScholarPubMed
Obaid, S, Jodoin, P-M, Morency, F, Descoteaux, M, Tucholka, A, Nguyen, D. Cortical thickness analysis in operculo-insular epilepsy. Organization for Human Brain Mapping Annual Meeting (OHBM); Geneva, Switzerland, 2016.Google Scholar
Obaid, S, Zerouali, Y, Nguyen, DK. Insular epilepsy: Semiology and noninvasive investigations. J Clin Neurophysiol. 2017;34(4):315–323.Google Scholar
Zerouali, Y, Pouliot, P, Robert, M, Mohamed, I, Bouthillier, A, Lesage, F, et al. Magnetoencephalographic signatures of insular epileptic spikes based on functional connectivity. Hum Brain Mapp. 2016;37(9):3250–3261.Google Scholar
Desai, A, Jobst, BC, Thadani, VM, Bujarski, KA, Gilbert, K, Darcey, TM, et al. Stereotactic depth electrode investigation of the insula in the evaluation of medically intractable epilepsy. J Neurosurg. 2011;114(4):1176–1186.Google Scholar
Weil, AG, Fallah, A, Lewis, EC, Bhatia, S. Medically resistant pediatric insular-opercular/perisylvian epilepsy. Part 1: Invasive monitoring using the parasagittal transinsular apex depth electrode. J Neurosurg Pediatr. 2016;18(5):511–522.Google Scholar
Matsumoto, R, Nair, DR, LaPresto, E, Najm, I, Bingaman, W, Shibasaki, H, et al. Functional connectivity in the human language system: A cortico-cortical evoked potential study. Brain. 2004;2004:2316–2330.Google Scholar
Lehman, R, Andermann, F, Olivier, A, Tandon, PN, Quesney, LF, Rasmussen, TB. Seizures with onset in the sensorimotor face area: clinical patterns and results of surgical treatment in 20 patients. Epilepsia. 1994;35(6):1117–1124.Google Scholar
Freri, E, Matricardi, S, Gozzo, F, Cossu, M, Granata, T, Tassi, L. Perisylvian, including insular, childhood epilepsy: Presurgical workup and surgical outcome. Epilepsia. 2017;58(8):1360–1369.Google Scholar
Ikegaya, N, Takahashi, A, Kaido, T, Kaneko, Y, Iwasaki, M, Kawahara, 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. 2018;128(4):1173–1177.Google Scholar
Engel, J Jr., Van Ness, P Rasmussen, C T B. Outcome with respect to epileptic seizures. In Engel, J, Jr., editor, Surgical treatment of the epilepsies, 2nd ed. New York: Raven; 1993. pp. 609–621.Google ScholarPubMed
Barba, C, Minotti, L, Job, AS, Kahane, P. The insula in temporal plus epilepsy. J Clin Neurophysiol. 2017;34(4):324–327.CrossRefGoogle ScholarPubMed
Blauwblomme, T, David, O, Minotti, L, Job, AS, Chassagnon, S, Hoffman, D, et al. Prognostic value of insular lobe involvement in temporal lobe epilepsy: A stereoelectroencephalographic study. Epilepsia. 2013;54(9):1658–1667.Google Scholar
Hale, AT, Sen, S, Haider, AS, Perkins, FF, Clarke, DF, Lee, MR, et al. Open resection versus laser interstitial thermal therapy for the treatment of pediatric insular epilepsy. Neurosurgery. 2019;85(4):E730–E736.CrossRefGoogle ScholarPubMed
Weil, AG, Le, NM, Jayakar, P, Resnick, T, Miller, I, Fallah, A, et al. Medically resistant pediatric insular-opercular/perisylvian epilepsy. Part 2: Outcome following resective surgery. J Neurosurg Pediatr. 2016;18(5):523–535.Google Scholar
d’Orio, P, Rizzi, M, Mariani, V, Pelliccia, V, Lo Russo, G, Cardinale, F, et al. Surgery in patients with childhood-onset epilepsy: Analysis of complications and predictive risk factors for a severely complicated course. J Neurol Neurosurg Psychiatry. 2019;90(1):84–89.Google Scholar
Boucher, O, Rouleau, I, Escudier, F, Malenfant, A, Denault, C, Charbonneau, S, et al. Neuropsychological performance before and after partial or complete insulectomy in patients with epilepsy. Epilepsy Behav. 2015;43:53–60.Google Scholar
Boucher, O, Rouleau, I, Lassonde, M, Lepore, F, Bouthillier, A, Nguyen, DK. Social information processing following resection of the insular cortex. Neuropsychologia. 2015;71:1–10.Google Scholar
Hébert-Seropian, B, Boucher, O, Sénéchal, C, Rouleau, I, Bouthillier, A, Lepore, F, et al. Does unilateral insular resection disturb personality? A study with epileptic patients. Journal of Clinical Neuroscience. 2017;43:121–125.Google Scholar
Ding, H, Zhou, J, Guan, Y, Zhai, F, Wang, M, Wang, J, et al. Bipolar electro-coagulation with cortextomy in the treatment of insular and insulo-opercular epilepsy explored by stereoelectro-encephalography. Epilepsy Res. 2018;145:18–26.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
×