Cameron Nathaniel, Fry Lane, Kabangu Jean-Luc, Schatmeyer Bryan A, Miller Christopher, Ulloa Carol M, Uysal Utku, Cheng Jennifer J, Kinsman Michael J, Rouse Adam G, Landazuri Patrick
Dept. of Neurosurgery, University of Kansas Medical Center, United States.
Dept. of Neurology, University of Kansas Medical Center, United States.
Heliyon. 2023 Jul 14;9(7):e18284. doi: 10.1016/j.heliyon.2023.e18284. eCollection 2023 Jul.
Insular epilepsy can be a challenging diagnosis due to overlapping semiology and scalp EEG findings with frontal, temporal, and parietal lobe epilepsies. Stereotactic electroencephalography (sEEG) provides an opportunity to better localize seizure onset. The possibility of improved localization is balanced by implantation risk in this vascularly rich anatomic region. We review both safety and pre-implantation factors involved in insular electrode placement across four years at an academic medical center.
Presurgical data, operative reports, and invasive EEG summaries were retrospectively reviewed for patients undergoing invasive epilepsy monitoring on the insula from 2016 through 2019. EEG reports were reviewed to record the presence of insula ictal and interictal involvement. We recorded which presurgical findings suggested insular involvement (insula lesion on MRI, insula changes on PET/SPECT/scalp EEG, characteristic semiology, or history of failed anterior temporal lobectomy). The likelihood of pre-sEEG insular onset was categorized as low suspicion if no presurgical findings were present ("rule out"), moderate suspicion if one finding was present, and high suspicion if two or more findings were present.
76 patients received 189 insular electrodes as part of their implantation strategy for 79 surgical cases. Seven patients (8.9%) had insular ictal onset. One clinically significant complication (left hemiparesis) occurred in a patient with moderate suspicion for insular onset. There were 38 low suspicion cases, 36 moderate suspicion cases, and 5 high suspicion cases for pre-sEEG insula ictal onset. Two low suspicion (5.3%), three moderate suspicion (8.6%), and two high suspicion (40%) cases had insular ictal onset.
The insula can safely receive sEEG. Having two or more presurgical factors indicating insular onset is a strong, albeit incomplete, predictor of insular seizure onset. Using pre-implantation clinical findings can offer clinicians predictive value for targeting the insula during invasive EEG monitoring.
由于岛叶癫痫的症状学以及头皮脑电图表现与额叶、颞叶和顶叶癫痫存在重叠，其诊断颇具挑战性。立体定向脑电图（sEEG）为更好地定位癫痫发作起始提供了契机。在这个血管丰富的解剖区域，定位改善的可能性与植入风险相权衡。我们回顾了一所学术医疗中心四年间岛叶电极植入所涉及的安全性和植入前因素。
对2016年至2019年接受岛叶侵入性癫痫监测的患者的术前数据、手术报告和侵入性脑电图总结进行回顾性分析。查阅脑电图报告以记录岛叶发作期和发作间期受累情况。我们记录了哪些术前发现提示岛叶受累（MRI上的岛叶病变、PET/SPECT/头皮脑电图上的岛叶改变、特征性症状学或颞叶前切除术失败史）。如果没有术前发现，则将术前sEEG岛叶起始的可能性归类为低怀疑（“排除”）；如果有一项发现，则为中度怀疑；如果有两项或更多发现，则为高度怀疑。
76例患者接受了189个岛叶电极作为79例手术病例植入策略的一部分。7例患者（8.9%）出现岛叶发作期起始。1例中度怀疑岛叶起始的患者发生了1例具有临床意义的并发症（左侧偏瘫）。术前sEEG岛叶发作期起始有38例低怀疑病例、36例中度怀疑病例和5例高度怀疑病例。2例低怀疑（5.3%）、3例中度怀疑（8.6%）和2例高度怀疑（40%）病例出现岛叶发作期起始。
岛叶能够安全地接受sEEG。有两项或更多提示岛叶起始的术前因素是岛叶癫痫发作起始的有力预测指标，尽管并不完整。利用植入前的临床发现可为临床医生在侵入性脑电图监测期间靶向岛叶提供预测价值。
