Ahmed Raheel, Otsubo Hiroshi, Snead Carter, Donner Elizabeth, Widjaja Elysa, Ochi Ayako, Drake James M, Rutka James T
Divisions of Neurosurgery and Neurology, Hospital for Sick Children, Toronto, Ontario, Canada.
Divisions of Neurosurgery and Neurology, Hospital for Sick Children, Toronto, Ontario, Canada.
Epilepsy Res. 2018 Feb;140:72-81. doi: 10.1016/j.eplepsyres.2017.12.011. Epub 2017 Dec 20.
The diagnosis and surgical management of pediatric patients with insular epilepsy is challenging due to variable and indistinct seizure semiology arising within the insular cortex. In addition, surgical approaches are associated with potential morbidity given the regional neurosurgical and vascular anatomy. Our institutional experience in evaluation and surgical management of insular epilepsy patients is presented. Diagnostic evaluation, surgical treatment and seizures outcomes are highlighted.
The institutional database for all pediatric surgical epilepsy patients was reviewed over a period of 15 years (2000-2015). Study subjects were defined as patients who had undergone surgical resection of the epileptogenic zone involving the insular cortex. Diagnostic imaging, electrophysiological studies and surgical records were assessed.
Six (n = 6) patients with insular epilepsy were identified with a mean follow up of 2.8 years (range: 0.8-6.8 years). Mean age at surgical resection was 9.5 ± 2.5 years (range: 2.5-16 years). Majority of patients (n = 4/6, 67%) underwent more than 1 surgical procedure. Magnetoencephalography (MEG) identified insular cortex involvement presurgically in all cases. MEG cluster localization was useful in guiding invasive EEG monitoring in 5 patients and was concordant with identification of epileptogenic zone through intracranial monitoring in all 5 patients. Surgical resection of the epileptogenic zone, as delineated through MEG spike sources and invasive EEG monitoring, was associated with favorable seizure outcome in 4 of 6 patients (67%; Engel Class I). Cortical dysgenesis was identified on histopathology in 4 cases.
Diagnostic evaluation through invasive and noninvasive electrophysiological studies is critical to identify pediatric patients with insular epilepsy. Our findings suggest that MEG may help with identifying the epileptogenic zone within the insular cortex, which could be confirmed with invasive intracranial monitoring.
由于岛叶皮质内出现的发作性症状多变且不明确，小儿岛叶癫痫患者的诊断和手术治疗具有挑战性。此外，鉴于该区域的神经外科和血管解剖结构，手术方法存在潜在的发病率。本文介绍了我们机构在岛叶癫痫患者评估和手术治疗方面的经验。重点介绍了诊断评估、手术治疗和癫痫发作结果。
回顾了15年（2000 - 2015年）期间所有小儿外科癫痫患者的机构数据库。研究对象定义为接受了涉及岛叶皮质的致痫区手术切除的患者。评估了诊断性影像学、电生理研究和手术记录。
确定了6例岛叶癫痫患者，平均随访2.8年（范围：0.8 - 6.8年）。手术切除时的平均年龄为9.5±2.5岁（范围：2.5 - 16岁）。大多数患者（n = 4/6，67%）接受了不止一次手术。术前所有病例的脑磁图（MEG）均显示岛叶皮质受累。MEG簇定位有助于指导5例患者进行侵入性脑电图监测，并且在所有5例患者中均与通过颅内监测确定的致痫区一致。通过MEG棘波源和侵入性脑电图监测确定的致痫区手术切除，使6例患者中的4例（67%；Engel I级）获得了良好的癫痫发作结果。4例患者的组织病理学检查发现皮质发育异常。
通过侵入性和非侵入性电生理研究进行诊断评估对于识别小儿岛叶癫痫患者至关重要。我们的研究结果表明，MEG可能有助于识别岛叶皮质内的致痫区，这可以通过侵入性颅内监测得到证实。
