Barba Carmen, Minotti Lorella, Job Anne-Sophie, Kahane Philippe
*Pediatric Neurology Unit, Neuroscience Department, Children's Hospital Meyer, Florence, Italy; †Neurology Department, CHU Grenoble Alpes, Grenoble, France; ‡University Grenoble Alpes, Grenoble Institute of Neuroscience, GIN, Grenoble, France; and §Inserm, U1216, Grenoble, France.
J Clin Neurophysiol. 2017 Jul;34(4):324-327. doi: 10.1097/WNP.0000000000000389.
Temporal lobe epilepsy (TLE) surgery is the most common type of surgical treatment offered to patients with drug-resistant focal seizures. However, the proportion of patients experiencing long-term freedom from seizures after TLE surgery remains suboptimal. Temporal plus epilepsy, which is characterized by a primary temporal epileptogenic zone extending to neighboring regions, has been demonstrated to be a major predictor of TLE surgery failures. In the context of the temporoperisylvian epilepsies, i.e., the most common type of temporal plus epilepsy, a possible role of the insula has often been hypothesized. As this area is buried deep within the lateral sulcus, the use of invasive recordings is often required. Identifying patients with temporal plus seizures is a relevant issue, as they appear to have a worse postsurgical seizure outcome compared with patients with "pure" temporal lobe seizures. Owing to these prognostic implications, it becomes important to identify, among patients suffering from "atypical" nonlesional TLEs, those who should undergo invasive investigations, in particular to explore the insula. In fact, only a primary involvement of the insula in the epileptogenic network may require to include this area in the resection to achieve seizure freedom. Using modern neurosurgical techniques, insular epilepsy surgery has proved to be safe and beneficial, making the "true" role of the insula in TLE surgery failures more relevant to understand. Further studies are needed to evaluate the efficacy of multilobar resections in patients with temporal plus epilepsy, in particular, when eloquent or difficult to access areas such as insula are suspected to be involved.
颞叶癫痫（TLE）手术是为药物难治性局灶性癫痫患者提供的最常见手术治疗方式。然而，TLE手术后长期无癫痫发作的患者比例仍不尽人意。颞叶附加型癫痫的特征是原发性颞叶致痫区扩展至邻近区域，已被证明是TLE手术失败的主要预测因素。在颞周岛盖癫痫（即最常见的颞叶附加型癫痫类型）的背景下，岛叶的可能作用常被推测。由于该区域深埋于外侧沟内，通常需要使用侵入性记录。识别患有颞叶附加型癫痫发作的患者是一个相关问题，因为与“单纯”颞叶癫痫患者相比，他们术后癫痫发作的结果似乎更差。鉴于这些预后影响，在患有“非典型”非病变性TLE的患者中识别出那些应接受侵入性检查（特别是探查岛叶）的患者变得很重要。事实上，只有当岛叶在致痫网络中起主要作用时，可能才需要在切除术中包括该区域以实现无癫痫发作。使用现代神经外科技术，岛叶癫痫手术已被证明是安全且有益的，这使得理解岛叶在TLE手术失败中的“真正”作用变得更加重要。需要进一步研究来评估多叶切除术对颞叶附加型癫痫患者的疗效，特别是当怀疑涉及如岛叶等功能区或难以触及的区域时。
