Vascular consequences of operculoinsular corticectomy for refractory epilepsy.

Abstract:

OBJECT:Surgery in the insular region is considered challenging because of its vascular relationships, the proximity of functional structures, and its deep location in the sylvian fissure. The authors report the incidence and consequences of ischemic lesions after operculoinsular corticectomy for refractory epilepsy. METHODS:The authors retrospectively reviewed the data of all patients who underwent an insular resection with or without an opercular resection for refractory epilepsy at their center. All patients underwent postoperative MRI, enabling a radiological analysis of the ischemic lesions as a result of the corticectomies. The resections were classified according to the location and extent of the insular corticectomy and the type of operculectomy. Each patient underwent clinical follow-up. RESULTS:Twenty patients underwent surgery. All patients underwent insular corticectomy with or without an operculectomy. Ischemic lesions were identified in 12 patients (60%). In these patients, 11 ischemic lesions (55%) were related to the insular corticectomy, and 1 was related to the associated periinsular resection. The ischemic lesions associated with the insulectomies were typically located in the corona radiata running from the insula to the periventricular region. Nine patients (45%) developed a postoperative neurological deficit, among whom 6 (67%) had an insular corticectomy-related ischemic lesion. All reported neurological deficits were transient. Five patients (25%) had ischemic lesions without neurological deficit. CONCLUSIONS:Operculoinsular corticectomies are associated with ischemic lesions in approximately 60% of patients. However, given that no patient had a definitive postoperative deficit, these ischemic lesions have few clinical consequences. Therefore, this surgical procedure can be considered reasonably safe for the treatment of refractory epilepsy.

journal_name

J Neurosurg

journal_title

Journal of neurosurgery

authors

Finet P,Nguyen DK,Bouthillier A

doi

10.3171/2014.10.JNS141246

subject

Has Abstract

pub_date

2015-06-01 00:00:00

pages

1293-8

issue

6

eissn

0022-3085

issn

1933-0693

journal_volume

122

pub_type

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