Artikel
Insular resections for drug-resistant epilepsy: results and prognostic factors
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Autoren
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Daniel Delev
- Department of Neurosurgery, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Deutschland
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Gerrit Haaker
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Deutschland
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Bernhard J. Steinhoff
- Epilepsiezentrum Kork, Kehl-Kork, Deutschland
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Christian Scheiwe
- Freiburg, Deutschland
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Julia M. Nakagawa
- Department of Neurosurgery, Freiburg, Deutschland
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Andreas Schulze-Bonhage
- Universitätsklinikum Freiburg, Neurozentrum, Epilepsiezentrum, Freiburg, Deutschland
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Josef Zentner
- Universitätsklinikum Freiburg, Neurozentrum, Abteilung für Allgemeine Neurochirurgie, Freiburg, Deutschland
| Veröffentlicht: | 9. Juni 2017 |
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Gliederung
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Objective: Surgery is a widely accepted option for treatment of pharmacoresistant focal epilepsy. One of the greatest challenges, however, refers to patients in whom the epileptogenic zone encroaches upon areas of high functionality such as the insular cortex. The aim of this study was to analyze clinical and epileptological results and to provide prognostic factors influencing seizure outcome after insular resections for drug-resistant epilepsy.
Methods: This single-center study comprises a consecutive series of 53 patients, who underwent resective surgery of insular cortex due to pharmacoresistant epilepsy. Comprehensive data including preoperative diagnostic modalities, surgical treatment, histopathological evaluation, and clinical as well as epileptological outcome were analyzed with a particular focus on prognostic factors.
Results: Twenty-four patients underwent pure insular resections, whereas in the remaining 29 cases resection included parts of the temporal or frontal cortex. Histopathological evaluation of the operative specimens revealed tumors (n=24), focal cortical dysplasia (n=22), cavernomas (n=4) and gliosis (n=3). The resection in most patients with focal cortical dysplasia (n=18; 81%) comprised insular and neighboring frontal or temporal cortex, while the resection of most glial tumors (n=15; 68%) was restricted to the insular cortex only. Seizure outcome data were available from 49 patients. After a mean follow-up of 52 months, 28 patients (57%) were free from disabling seizures (Engel class I) and 35 patients (66%) had favorable seizure outcome (Engel classes I and II). There was no perioperative death. Permanent morbidity was encountered in 10 cases (19%) and included in most patients mild hemiparesis or dysphasia. The following prognostic factors were associated with excellent seizure outcome: MRI visible lesion (p=0.039), complete resection of the lesion (p=0.013) and younger age at surgery (<18 years) (p=0.032). Evaluation of histopathological findings revealed that glial tumors were associated with a poor seizure outcome (p=0.020).
Conclusion: Surgical treatment of pharmacoresistant epilepsy arising from the insular cortex provides satisfying results with seizure free rates of almost 60% and acceptable morbidity. Best epileptological outcome can be achieved in younger patients with dysplastic lesions that can be resected completely, while patients with glial tumors are less likely to become seizure free.
