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58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

26. bis 29.04.2007, Leipzig

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Epilepsy surgery for insular lesions

Epilepsiechirurgie insulärer Läsionen

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  • corresponding author M. von Lehe - Klinik für Neurochirurgie, Universitätsklinikum Bonn
  • J. Wellmer - Klinik für Epileptologie, Universitätsklinikum Bonn
  • H. Urbach - Klinik für Radiologie, Universitätsklinikum Bonn
  • T. Kral - Klinik für Neurochirurgie, Universitätsklinikum Bonn
  • J. Schramm - Klinik für Neurochirurgie, Universitätsklinikum Bonn
  • H. Clusmann - Klinik für Neurochirurgie, Universitätsklinikum Bonn

Deutsche Gesellschaft für Neurochirurgie. 58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC). Leipzig, 26.-29.04.2007. Düsseldorf: German Medical Science GMS Publishing House; 2007. DocSO.06.08

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2007/07dgnc253.shtml

Published: April 11, 2007

© 2007 von Lehe et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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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.