Park Young Seok, Lee Yun Ho, Shim Kyu Won, Lee Yoon Jin, Kim Heung Dong, Lee Joon-Soo, Kim Dong-Seok
Pediatric Neurosurgery, Pediatric Epilepsy Clinic, Severance Children's Hospital, Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, 134, Shinchon-dong, Seodaemoon-gu, Seoul 120-752, Republic of Korea.
Childs Nerv Syst. 2009 May;25(5):591-7. doi: 10.1007/s00381-008-0764-8. Epub 2009 Jan 13.
The unfavorable surgical results that have been reported with insular epilepsy surgery may be related to inadequate monitoring. Insular epilepsy surgery requires the precise monitoring and tailored removal of the epileptic zone. The purposes of this study were to precisely monitor the hidden cortex and determine the effectiveness of using different monitoring methods, including subpial depth electrodes.
This is a study of a single center series of six patients (three men, three women) who underwent insular surgery between May 2006 and December 2007. All patients had experienced medically intractable seizures without any evidence of a tumorous condition based on previous examination. We used strip electrode implantation in one patient and stereotactic depth electrode insertion in two patients, which resulted in partial removal of the insular. The other three patients underwent open direct subpial depth electrode insertion, which resulted in total removal of the insular cortex.
There were no surgery-related complications with the insulectomy after insertion of the subpial depth electrodes, regardless of the monitoring method or extent of removal. All patients except for one showed considerable improvement in epilepsy (83.3% Engle class I, 16.5% Engle class II). In the three patients who had open direct subpial depth electrodes inserted, we achieved total insulectomy without increasing the surgical morbidity, while in the other three patients, the insular removal was only partial.
We demonstrate that image-guided insular surgery with safe and accurate depth electrode guidance results in an optimal outcome and complete resection of the insular cortex.
有报道称岛叶癫痫手术的不良手术结果可能与监测不足有关。岛叶癫痫手术需要精确监测并针对性地切除癫痫区域。本研究的目的是精确监测隐藏皮层，并确定使用不同监测方法（包括软膜下深度电极）的有效性。
这是一项对2006年5月至2007年12月间在单一中心接受岛叶手术的6例患者（3男3女）的系列研究。所有患者均经历了药物难治性癫痫发作，且根据先前检查无任何肿瘤性病变的证据。我们对1例患者采用条状电极植入，对2例患者采用立体定向深度电极插入，均实现了岛叶的部分切除。另外3例患者接受了开放性直接软膜下深度电极插入，实现了岛叶皮质的完全切除。
无论监测方法或切除范围如何，软膜下深度电极插入后进行岛叶切除术均未出现与手术相关的并发症。除1例患者外，所有患者的癫痫症状均有显著改善（恩格尔分级I级占83.3%，恩格尔分级II级占16.5%）。在3例接受开放性直接软膜下深度电极插入的患者中，我们实现了岛叶的完全切除且未增加手术发病率，而在另外3例患者中，岛叶仅为部分切除。
我们证明，在安全准确的深度电极引导下进行的影像引导岛叶手术可取得最佳效果，并能完全切除岛叶皮质。
