Epilepsy surgery in children with operculo-insular epilepsy: Results of a large unicentric cohort

Kód výsledku v IS VaVaI

<a href="https://www.isvavai.cz/riv?ss=detail&h=RIV%2F68407700%3A21230%2F25%3A00377936" target="_blank" >RIV/68407700:21230/25:00377936 - isvavai.cz</a>

Nalezeny alternativní kódy

RIV/00216208:11130/25:10488409 RIV/00064203:_____/25:10488409

Výsledek na webu

<a href="https://doi.org/10.1111/epi.18185" target="_blank" >https://doi.org/10.1111/epi.18185</a>

DOI - Digital Object Identifier

<a href="http://dx.doi.org/10.1111/epi.18185" target="_blank" >10.1111/epi.18185</a>

Jazyk výsledku

angličtina

Název v původním jazyce

Epilepsy surgery in children with operculo-insular epilepsy: Results of a large unicentric cohort

Popis výsledku v původním jazyce

Objective: Epilepsy surgery in the operculo-insular cortex is challenging due to the difficult delineation of the epileptogenic zone and the high risk of post-operative deficits following resections in this region. Methods: Pre- and post-surgical data from 30 pediatric patients who underwent opercular-insular cortex surgery at Motol Epilepsy Center Prague from 2010 to 2022 were analyzed. Results: Focal cortical dysplasia (FCD, n = 15, 50%) was the predominant cause of epilepsy in the patients studied, 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, histology was negative. Seven patients (23%) displayed normal MRI results. Seizures exhibited diverse semiology and propagation patterns (i.e., frontal, perisylvian, and temporal). Ictal and interictal EEG findings observed during video EEG were mostly extensive. Multimodal imaging and advanced post-processing were frequently utilized. Stereoelectroencephalography (SEEG) monitoring was used for localizing the epileptogenic zone and eloquent cortex in 23 patients (77%). Oblique electrodes were used as guides for better orientation of neurosurgeons during resection. The epileptogenic zone was in the dominant hemisphere in 16 patients. At the two-year follow-up, 22 patients (73%) were completely seizure-free, and eight (27%) experienced a seizure frequency reduction of > 50% (ILAE 3 and 4). Fourteen patients (47%) underwent anti-seizure medication tapering; treatment was completely withdrawn in two patients (7%). Nineteen patients (63%) remained seizure-free following the definitive outcome assessment (median: 6 years and 5 months, range: 2 years to 13 years and 5 months post-surgery). Six patients (20 %) experienced corona radiata or basal ganglia ischemia; four (13%) improved to mild hemiparesis, and one (3%) to moderate hemiparesis with ongoing rehabilitation. Two patients (7 %) operated on in the anterior insula, along with fronto-temporal resection experienced major complications - pontine ischemia and post-operative brain edema. Significance: Epilepsy surgery in the opercular-insular cortex can lead to excellent patient outcomes. A comprehensive diagnostic approach is crucial for surgical success. There is a great chance for significant recovery of postoperative deficits with the use of rehabilitation.

Název v anglickém jazyce

Epilepsy surgery in children with operculo-insular epilepsy: Results of a large unicentric cohort

Popis výsledku anglicky

Objective: Epilepsy surgery in the operculo-insular cortex is challenging due to the difficult delineation of the epileptogenic zone and the high risk of post-operative deficits following resections in this region. Methods: Pre- and post-surgical data from 30 pediatric patients who underwent opercular-insular cortex surgery at Motol Epilepsy Center Prague from 2010 to 2022 were analyzed. Results: Focal cortical dysplasia (FCD, n = 15, 50%) was the predominant cause of epilepsy in the patients studied, 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, histology was negative. Seven patients (23%) displayed normal MRI results. Seizures exhibited diverse semiology and propagation patterns (i.e., frontal, perisylvian, and temporal). Ictal and interictal EEG findings observed during video EEG were mostly extensive. Multimodal imaging and advanced post-processing were frequently utilized. Stereoelectroencephalography (SEEG) monitoring was used for localizing the epileptogenic zone and eloquent cortex in 23 patients (77%). Oblique electrodes were used as guides for better orientation of neurosurgeons during resection. The epileptogenic zone was in the dominant hemisphere in 16 patients. At the two-year follow-up, 22 patients (73%) were completely seizure-free, and eight (27%) experienced a seizure frequency reduction of > 50% (ILAE 3 and 4). Fourteen patients (47%) underwent anti-seizure medication tapering; treatment was completely withdrawn in two patients (7%). Nineteen patients (63%) remained seizure-free following the definitive outcome assessment (median: 6 years and 5 months, range: 2 years to 13 years and 5 months post-surgery). Six patients (20 %) experienced corona radiata or basal ganglia ischemia; four (13%) improved to mild hemiparesis, and one (3%) to moderate hemiparesis with ongoing rehabilitation. Two patients (7 %) operated on in the anterior insula, along with fronto-temporal resection experienced major complications - pontine ischemia and post-operative brain edema. Significance: Epilepsy surgery in the opercular-insular cortex can lead to excellent patient outcomes. A comprehensive diagnostic approach is crucial for surgical success. There is a great chance for significant recovery of postoperative deficits with the use of rehabilitation.

Druh

J_imp - Článek v periodiku v databázi Web of Science

CEP obor

—

OECD FORD obor

20601 - Medical engineering

Projekt

Výsledek vznikl pri realizaci vícero projektů. Více informací v záložce Projekty.

Návaznosti

P - Projekt vyzkumu a vyvoje financovany z verejnych zdroju (s odkazem do CEP)

Rok uplatnění

2025

Kód důvěrnosti údajů

S - Úplné a pravdivé údaje o projektu nepodléhají ochraně podle zvláštních právních předpisů

Název periodika

Epilepsia

ISSN

0013-9580

e-ISSN

1528-1167

Svazek periodika

66

Číslo periodika v rámci svazku

2

Stát vydavatele periodika

US - Spojené státy americké

Počet stran výsledku

14

Strana od-do

444-457

Kód UT WoS článku

001371370100001

EID výsledku v databázi Scopus

2-s2.0-85210999922