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Chapter 22 - Insular Epilepsy Surgery: Surgical Techniques and Experience of Various Centers

from Section 5 - Surgical Management of Insular Epilepsy

Published online by Cambridge University Press:  09 June 2022

By
Alain Bouthillier ,
Stephan Chabardes ,
Massimo Cossu  and
Jorge Gonzalez-Martinez
Edited by
Dang Nguyen ,
Jean Isnard  and
Philippe Kahane
Dang Nguyen
Affiliation:
Université de Montréal
Jean Isnard
Affiliation:
Claude Bernard University Lyon
Philippe Kahane
Affiliation:
Grenoble-Alpes University Hospital
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Summary

Refractory epilepsy from operculoinsular origin is increasingly recognized because of published descriptions of its clinical presentations, more attention in the interpretation of non-invasive focus localization techniques, and the development of invasive electrode implantation schemes to sample that area. Microsurgical techniques of operculo-insular cortical resection have been refined, taking into consideration the complex and deep anatomy and the high vascularity of the perisylvian area. Selective transsylvian and/or subpial transopercular insulectomies are performed, depending on the definition of the extent of cortectomy needed and the functional areas to preserve. Seizure control results after surgery are similar than those in other brain locations. Neurological complications and neuropsychological consequences are acceptable. It is crucial that these highly selected patients be investigated and operated in epilepsy centers dedicated to this complex type of refractory epilepsy, both to optimize the results of seizure control and keep the complication rate as low as possible.

Keywords

insular surgeryinsulectomyoperculoinsulectomysurgical complications
Type
Chapter
Information
Insular Epilepsies , pp. 257 - 265
Publisher: Cambridge University Press
Print publication year: 2022

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