Insular Cortex Surgery for the Treatment of Refractory Epilepsy

Journal of Clinical Neurophysiology : Official Publication of the American Electroencephalographic Society
M von Lehe, Yaroslav Parpaley

Abstract

Focal epilepsy originating from the insular cortex is rare. One reason is the small amount of cortical tissue compared with other lobes of the brain. However, the incidence of insular epilepsy might be underestimated because of diagnostic difficulties. The semiology and the surface EEG are often not meaningful or even misleading, and elaborated imaging might be necessary. The close connections of the insular cortex with other potentially epileptogenic areas, such as the temporal lobe or frontal/central cortex, is increasingly recognized as possible reason for failure of epilepsy surgery for temporal or extratemporal seizures. Therefore, some centers consider invasive EEG recording of the insular cortex not only in case of insular epilepsy but also in other focal epilepsies with nonconclusive results from the presurgical work-up. The surgical approach to and resection of insular cortex is challenging because of its deep location and proximity to highly eloquent brain structures. Over the last decades, technical adjuncts like navigation tools, electrophysiological monitoring and intraoperative imaging have improved the outcome after surgery. Nevertheless, there is still a considerable rate of postoperative transient or permanent ...Continue Reading

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Citations

Aug 14, 2018·Journal of Neurology, Neurosurgery, and Psychiatry·Piergiorgio d'OrioMassimo Cossu
Oct 28, 2019·Neurology·Eduardo E Benarroch
Feb 11, 2020·The Canadian Journal of Neurological Sciences. Le Journal Canadien Des Sciences Neurologiques·Juan S BottanDavid A Steven
Mar 7, 2019·Epilepsy Currents·Barbara C JobstFred Lado
Jan 11, 2019·Child's Nervous System : ChNS : Official Journal of the International Society for Pediatric Neurosurgery·Hepzibha AlexanderChima O Oluigbo
Mar 24, 2020·Seizure : the Journal of the British Epilepsy Association·Pablo KappenFriederike Moeller
Jul 6, 2021·Frontiers in Neurorobotics·Yueyan HuangLianghua Liao

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