Neurosurgery Department, University Hospital of Liège, Liège, Belgium.
CNRS CRAN UMR 7039, Vandœuvre-lès-Nancy, France.
Oper Neurosurg (Hagerstown). 2018 Jan 1;14(1):1-8. doi: 10.1093/ons/opx106.
The exploration of the insula in pre-surgical evaluation of epilepsy is considered to be associated with a high vascular risk resulting in an incomplete exploration of the insular cortex.
To report a retrospective observational study of insular exploration using stereoelectroencephalography (sEEG) with transopercular and parasagittal oblique intracerebral electrodes from January 2008 to January 2016. The first purpose of this study was to evaluate the surgical risks of insular cortex sEEG exploration. The second purpose was to define the ability of placing intracerebral contacts in the whole insular cortex.
Ninety-nine patients underwent 108 magnetic resonance imaging (MRI)-guided stereotactic implantations of intracerebral electrodes in the context of preoperative assessment of drug-resistant epilepsy, including at least 1 electrode placed in the insular cortex. On postoperative computed tomography images co-registered with MRI, followed by MRI segmentation and application of a transformation matrix, intracerebral contact coordinates of the insular electrodes' contacts were anatomically localized in the Talairach space. Finally, dispersion and clustering analysis was performed.
There was no morbidity, in particular hemorrhagic complications, or mortality related to insular electrodes. Statistical comparison of intracerebral contact positions demonstrated that whole insula exploration is possible on the left and right sides. In addition, the clustering analysis showed the homogeneous distribution of the electrodes within the insular cortex.
In the presurgical evaluation of drug-resistant epilepsy, the insular cortex can be explored safely and comprehensively using transopercular sEEG electrodes. Parasagittal oblique trajectories may also be associated to achieve an optimal exploration.
在癫痫的术前评估中探索岛叶被认为与高血管风险相关，导致岛叶皮质的不完全探索。
报告 2008 年 1 月至 2016 年 1 月期间使用经颅和矢状旁斜行脑内电极进行立体脑电图（sEEG）的岛叶探索的回顾性观察研究。本研究的第一个目的是评估岛叶皮质 sEEG 探索的手术风险。第二个目的是确定在整个岛叶皮质中放置脑内电极的能力。
99 例患者在药物难治性癫痫术前评估中接受了 108 例 MRI 引导的立体定向脑内电极植入，其中至少有 1 个电极放置在岛叶皮质。在术后与 MRI 配准的 CT 图像上，对脑内电极的接触点进行 MRI 分割和应用变换矩阵，将其解剖定位在 Talairach 空间。最后，进行了分散和聚类分析。
没有与岛叶电极相关的发病率，特别是出血性并发症或死亡率。脑内接触点位置的统计学比较表明，左右两侧都可以进行整个岛叶的探索。此外，聚类分析显示电极在岛叶皮质内的均匀分布。
在药物难治性癫痫的术前评估中，可以使用经颅 sEEG 电极安全、全面地探索岛叶。矢状旁斜行轨迹也可能与实现最佳探索相关。
