Bipolar electro-coagulation with cortextomy in the treatment of insular and insulo-opercular epilepsy explored by stereoelectro-encephalography

Abstract

Objective: The diagnosis and treatment of insular and insulo-opercular epilepsy remain underexplored because the insula is covered by the insulo-opercular and a dense vascular curtain. Stereoelectro-encephalography (SEEG) is a reliable and recommended technique for locating the epileptic zone, especially in insular and insulo-opercular regions (Isnard et al., 2000, 2004). Bipolar electro-coagulation with cortextomy is an alternative therapy for treating drug-resistant epilepsy and is more convenient and less likely to cause adverse complications. We report 20 patients with insular and insulo-opercular epilepsy diagnosed through SEEG who underwent surgical treatment via bipolar electro-coagulation with cortextomy. The outcomes and findings are presented as a retrospective analysis (Cui et al., 2012; Zhai et al., 2015).

Method: We performed a retrospective analysis of 20 insular and insulo-opercular epilepsy patients. All patients involved in the analysis had undergone a comprehensive presurgical evaluation, including video electro-encephalographic recordings (at least 1 insultus), SEEG (at least 3 electrodes placed at insular depth), magnetic resonance imaging, positron emission tomography, and magneto-encephalography. All patients underwent bipolar electro-coagulation with cortextomy surgery. The follow-up time was over 24 months.

Result: After bipolar electro-coagulation with cortextomy surgical treatment, 16 of the 20 patients (80.0%) were seizure free (Engel class I), and all patients achieved satisfactory seizure control (Engel class I-III) with a mean follow-up of 29.6 months (range, 24-39 months). Histopathological findings demonstrated focal cortical dysplasia in 14 patients (70.0%), neuro-damage in 3 patients (15.0%), ganglioglioma in 2 patients (10.0%), and gliosis in 1 patient (5.0%). Sixteen of the 20 patients reported no complications (80.0%), 3 exhibited temporary complications that recovered within 3 months (15.0%), and 1 patient experienced permanent complications (5.0%).

Significance: Bipolar electro-coagulation with cortextomy of the insular and insulo-opercular cortex explored by SEEG findings can be performed safely and resulted in satisfactory seizure control.

Keywords: Bipolar electro-coagulation; Epilepsy surgery; Insular and insulo-opercular cortex; Refractory epilepsy; Stereoelectro-encephalography (SEEG).