Artikel
Epilepsy surgery for insular lesions
Epilepsiechirurgie insulärer Läsionen
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Veröffentlicht: | 11. April 2007 |
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Objective: Surgical treatment of deep-seated insular lesions causing refractory epilepsy is thought to be difficult due to the proximity of eloquent areas. In this study we report our experience with epilepsy surgery of the insular region.
Methods: The data of 21 patients who underwent epilepsy surgery for a lesion involving the insular region were retrospectively collected. In 5 cases the pre-op MRI revealed a lesion solely located in the insula, and in 16 cases the lesion extended to the frontal (n=3) or temporal (n=7) lobe or was multilobar (n=6). Fifteen resections were done on the right side. The mean age was 26 (4 to 62) years including 4 children (<10 years). We analysed the medical history, the pre-surgical diagnostics and post-operative outcome at a mean follow-up period of 52 (3-199) months with respect to functional and seizure outcome.
Results: Five patients required invasive EEG recording with implanted electrodes, 2 patients were operated with intra-op ECOG. In 10 cases we used electrophysiological monitoring intra-operatively and in 3 cases neuronavigation. According to the ILAE classification (last available outcome, lao) 11 patients were seizure free (52.4%, ILAE 1). Two patients continued to have auras (9.5%, ILAE 2) and 3 patients had up to 3 seizure days per year (14.3%, ILAE 3), resulting in 76.2% of the patients who had a satisfactory seizure outcome. Less favourable results were achieved in 5 patients (23.8%, ILAE 4: 4 seizure days per year to 50% reduction of the seizure frequency). Post-operatively, 4 patients suffered from a transient neurological deficit (hemiparesis, hemihypesthesia or dysphasia), one patient had a permanent deterioration of a pre-existing hemiparesis and two had a scotoma. One patient required re-operation for completion of the resection. The histopathological examination revealed 5 cases of focal cortical dysplasia (FCD), 4 gangliogliomas, 2 dysembryoplastic neuroepithelial tumours, 5 other gliomas (WHO II-III), 2 cavernomas and 3 cases of gliosis.
Conclusions: Lesionectomy of insular lesions can be performed acceptably safe and provides a surprisingly high rate of seizure relief in patients with chronic drug resistant epilepsy.