Pepper J, Seri S, Walsh A R, Agrawal S, Macpherson L, Sudarsanam A, Lo W B
Department of Neurosurgery, Birmingham Children's Hospital, Birmingham, UK.
Department of Neurophysiology, Birmingham Children's Hospital, Birmingham, UK.
Childs Nerv Syst. 2024 Dec 9;41(1):41. doi: 10.1007/s00381-024-06661-9.
Stereoelectroencephalography (SEEG) is widely used to characterise epileptic networks and guide resection in paediatric epilepsy surgery programmes. The insula, with its extensive connectivity with temporal and extratemporal structures, has increasingly been seen as a possible surgical target. We report our seizure outcomes after SEEG-guided resection of the insula in a paediatric cohort.
From our paediatric epilepsy surgery database of patients aged 0-19 years, we analysed demographic and clinical data of those who underwent SEEG-guided insula cortex resection.
In total, 11 children (7 females, 4 males) who underwent SEEG-guided resection were identified. The mean age at first SEEG was 13 years old. Mean age at seizure onset was 4.3 years; seizure frequency ranged from 50/day to 2/week. Four children required 1 SEEG study, 6 children 2 SEEG, and 1 child underwent 3 SEEG recordings. The mean follow-up duration was 2.1 years; at the latest follow-up, three children had Engel I, 2 children Engel III, and 6 children Engel IV. One child classified as an Engel IV outcome for insular surgery had Engel class I after 2 failed insula surgeries, after an occult frontal focal cortical dysplasia was later identified and resected. No major complications were noted.
In our paediatric series, one third of the patients undergoing insula cortex surgery after SEEG became seizure free but this may require repeat SEEG implantation, repeat resective surgery and the possibility of changing hypothesis from the insula cortex to nearby foci.
立体定向脑电图（SEEG）广泛应用于小儿癫痫手术中癫痫网络的特征描述及手术切除的指导。岛叶与颞叶及颞叶外结构广泛相连，越来越被视为一个可能的手术靶点。我们报告了小儿队列中SEEG引导下岛叶切除术后的癫痫发作结果。
从我们0至19岁小儿癫痫手术患者数据库中，分析接受SEEG引导下岛叶皮质切除术患者的人口统计学和临床数据。
共确定11例接受SEEG引导下切除术的儿童（7例女性，4例男性）。首次SEEG检查时的平均年龄为13岁。癫痫发作起始的平均年龄为4.3岁；癫痫发作频率从每日50次至每周2次不等。4例儿童需要1次SEEG检查，6例儿童需要2次SEEG检查，1例儿童接受了3次SEEG记录。平均随访时间为2.1年；在最近一次随访时，3例儿童为恩格尔I级，2例儿童为恩格尔III级，6例儿童为恩格尔IV级。1例因岛叶手术被分类为恩格尔IV级结果的儿童，在2次岛叶手术失败后，恩格尔分级为I级，后来发现并切除了隐匿性额叶局灶性皮质发育不良。未观察到重大并发症。
在我们的小儿系列研究中，接受SEEG引导下岛叶皮质手术后三分之一的患者癫痫发作停止，但这可能需要重复SEEG植入、重复切除手术，以及将假设从岛叶皮质转变为附近病灶的可能性。
