Kudr Martin, Janca Radek, Jahodova Alena, Belohlavkova Anezka, Ebel Matyas, Bukacova Katerina, Maulisova Alice, Tichy Michal, Liby Petr, Kyncl Martin, Holubova Zuzana, Sanda Jan, Jezdik Petr, Mackova Katerina, Ramos Rivera Gonzalo Alonso, Kopac Luka, Krsek Pavel
Department of Paediatric Neurology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic.
European Reference Network EpiCARE, Prague, Czech Republic.
Epilepsia. 2025 Feb;66(2):444-457. doi: 10.1111/epi.18185. Epub 2024 Dec 5.
Epilepsy surgery in the operculoinsular cortex is challenging due to the difficult delineation of the epileptogenic zone and the high risk of postoperative deficits.
Pre- and postsurgical data from 30 pediatric patients who underwent operculoinsular cortex surgery at the Motol Epilepsy Center Prague from 2010 to 2022 were analyzed.
Focal cortical dysplasia (FCD; n = 15, 50%) was the predominant cause of epilepsy, followed by epilepsy-associated tumors (n = 5, 17%) and tuberous sclerosis complex (n = 2, 7%). In eight patients where FCD was the most likely etiology, the histology was negative. Seven patients (23%) displayed normal magnetic resonance imaging results. Seizures exhibited diverse semiology and propagation patterns (frontal, perisylvian, and temporal). The ictal and interictal electroencephalographic (EEG) findings were mostly extensive. Multimodal imaging and advanced postprocessing were frequently used. Stereo-EEG was used for localizing the epileptogenic zone and eloquent cortex in 23 patients (77%). Oblique electrodes were used as guides for better neurosurgeon orientation. The epileptogenic zone was in the dominant hemisphere in 16 patients. At the 2-year follow-up, 22 patients (73%) were completely seizure-free, and eight (27%) experienced a seizure frequency reduction of >50% (International League Against Epilepsy class 3 and 4). Fourteen patients (47%) underwent antiseizure medication tapering; treatment was completely withdrawn in two (7%). Nineteen patients (63%) remained seizure-free following the definitive outcome assessment (median = 6 years 5 months, range = 2 years to 13 years 5 months postsurgery). Six patients (20%) experienced corona radiata or basal ganglia ischemia; four (13%) improved to mild and one (3%) to moderate hemiparesis. Two patients (7%) operated on in the anterior insula along with frontotemporal resection experienced major complications: pontine ischemia and postoperative brain edema.
Epilepsy surgery in the operculoinsular cortex can lead to excellent patient outcomes. A comprehensive diagnostic approach is crucial for surgical success. Rehabilitation brings a great chance for significant recovery of postoperative deficits.
由于癫痫发作起始区难以界定且术后出现功能缺损的风险较高，因此岛盖部皮质的癫痫手术具有挑战性。
对2010年至2022年在布拉格莫托尔癫痫中心接受岛盖部皮质手术的30例儿科患者的术前和术后数据进行分析。
局灶性皮质发育不良（FCD；n = 15，50%）是癫痫的主要病因，其次是癫痫相关肿瘤（n = 5，17%）和结节性硬化症（n = 2，7%）。在8例最可能的病因是FCD的患者中，组织学检查结果为阴性。7例患者（23%）磁共振成像结果正常。癫痫发作表现出多样的症状学和传播模式（额叶、外侧裂周围和颞叶）。发作期和发作间期脑电图（EEG）表现大多较为广泛。多模态成像和先进的后处理技术经常被使用。23例患者（77%）使用立体定向脑电图来定位癫痫发作起始区和明确的皮质功能区。使用倾斜电极作为引导，以便神经外科医生更好地定位。癫痫发作起始区位于优势半球的患者有16例。在2年的随访中，22例患者（73%）完全无癫痫发作，8例（27%）癫痫发作频率降低>50%（国际抗癫痫联盟3级和4级）。14例患者（47%）逐渐减少抗癫痫药物用量；2例（7%）完全停药。在最终结果评估后，19例患者（63%）仍无癫痫发作（中位数=6年5个月，范围=术后2年至13年5个月）。6例患者（20%）出现放射冠或基底节区缺血；4例（13%）改善为轻度偏瘫，1例（3%）改善为中度偏瘫。2例在前岛叶连同额颞叶切除术一起进行手术的患者出现了严重并发症：脑桥缺血和术后脑水肿。
岛盖部皮质的癫痫手术可使患者获得良好的治疗效果。全面的诊断方法对手术成功至关重要。康复治疗为术后功能缺损显著恢复带来了很大机会。
