Department of Neurological Surgery, Germans Trias i Pujol University Hospital Barcelona, Ctra del Canyet sn, Badalona, Barcelona, CP 08916, Spain.
Department of Pediatric Neurological Surgery, Hospital Sant Joan de Déu de Barcelona, Barcelona, Spain.
Childs Nerv Syst. 2024 Nov;40(11):3729-3744. doi: 10.1007/s00381-024-06571-w. Epub 2024 Sep 5.
Insular epilepsy is a well-known cause of drug-resistant epilepsy (DRE) in the pediatric population. It can be a source of surgical epilepsy treatment failures when not ruled out pre-operatively. Non-invasive methods often provide limited information about its existence, being the invasive methods necessary to diagnose it in the vast majority of cases. The most used is stereoelectroencephalography (SEEG). We report a series of DRE pediatric patients in which insular SEEG was performed to rule out insular epilepsy.
We performed a retrospective review of pediatric DRE patients operated on SEEG including insular electrodes between April 2016 and September 2022. We described the different trajectories used (orthogonal or oblique) and surgical techniques. After implantation, we assessed electrodes' precision using three measures: entry point location error (EPLE), target point location error (TPLE), and target deviation (TD). We also reported complications that occurred with this technique as well as the diagnostic information provided.
Overall, 32 DRE patients were operated on SEEG including insular electrodes. Four hundred one electrodes were implanted, 148 (39.91%) of whom were directed to the insula. One hundred twelve followed an orthogonal trajectory, and 36 were oblique. The mean EPLE was 1.45 mm, TPLE was 1.88 mm and TD was 0.71 mm. Three patients suffered from frontal hematoma, two of them diagnosed on post-operative MRI and one who required surgery, with no sequelae. One patient suffered from meningitis treated with antibiotics with no permanent sequelae. Nine patients (28.13%) had the insula included in the epileptogenic zone.
Insular epilepsy has to be ruled out in DRE patients when little suspicion is obtained after non-invasive testing. This is especially important in the pediatric population, in which seizure semiology is more difficult to characterize and failures to control epilepsy have devastating consequences in neurocognitive development and scholarship. Given its relative low rate of relevant complications and potential benefits, we should consider widening the inclusion criteria for insular SEEG monitoring.
岛叶癫痫是小儿耐药性癫痫（DRE）的一个已知病因。如果术前未排除，它可能成为手术治疗癫痫失败的根源。非侵入性方法通常提供的关于其存在的信息有限，绝大多数情况下需要采用侵入性方法来诊断。最常用的是立体脑电图（SEEG）。我们报告了一系列 DRE 小儿患者，他们接受了岛叶 SEEG 以排除岛叶癫痫。
我们对 2016 年 4 月至 2022 年 9 月期间接受 SEEG 手术包括岛叶电极的小儿 DRE 患者进行了回顾性研究。我们描述了使用的不同轨迹（正交或斜交）和手术技术。植入后，我们使用三个指标评估电极的精度：进入点位置误差（EPLE）、目标点位置误差（TPLE）和目标偏差（TD）。我们还报告了该技术引起的并发症以及提供的诊断信息。
总体而言，32 名 DRE 患者接受了 SEEG 手术，包括岛叶电极。共植入 401 个电极，其中 148 个（39.91%）指向岛叶。112 个采用正交轨迹，36 个采用斜交轨迹。平均 EPLE 为 1.45 毫米，TPLE 为 1.88 毫米，TD 为 0.71 毫米。3 名患者出现额部血肿，其中 2 例在术后 MRI 上诊断，1 例需要手术，无后遗症。1 名患者患有脑膜炎，经抗生素治疗后无后遗症。9 名患者（28.13%）的岛叶被纳入致痫区。
在非侵入性检查后怀疑较小的 DRE 患者中，应排除岛叶癫痫。这在小儿患者中尤为重要，因为癫痫发作的半侧性更难确定，如果癫痫不能得到控制，对神经认知发育和学业成绩会产生毁灭性的后果。鉴于其相对较低的相关并发症发生率和潜在益处，我们应考虑扩大岛叶 SEEG 监测的纳入标准。
