| Objective:To summarize and analyze the clinical features, preoperative localizing methods and surgery outcome of patients with insular and perisylvian epilepsy, and to evaluate the effectiveness and safety of epileptic focus resection through transopercular approach.Methods:Retrospective study of 23 patients who underwent surgery for insular and perisylvian cortex resection through trans-opercular approach from January 2008 to December 2015, in the Department of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University. The clinical preoperative assessment data, including ictal semiology, video scalp-EEG, MRI, MEG, intracranial electroencephalograph, had been collected and analyzed. Follow up for functional morbidity and seizure outcome through telephone for all patients. Patients who have been followed up more than one year are evaluated by Engel classification, and record the seizure frequency of patients have been followed up within one year.Results:Twenty-three patients were included in this study, fourteen patients(60.87%) kept conscious during seizures, and 70.56% ictal symptoms occurred at night.Except for 1 patient, twenty-two patients had auras, six patients with vegetative auras, five with visceral sensory auras, five with somatosensory auras, two patients with both somatosensory and visceral sensory auras, one patient with both somatosensory and vegetative auras, two with auditory auras and one with taste aura.Thirteen patients with elementary motor symptoms and 7 with integrated motor symptoms, three patients with mixture of two motor symptoms, eleven patients with generalized tonic clonic seizures, and 5 paitients with hypermotor seizures. MRI show the abnormal signal of insular or perisylvian cortex in 9 of 23 patients, and among 15 patients with MEG, spike dipoles were located in insular or perisylvian cortex in 12 cases. Video scalp-EEG data of 21 patients were summarized, abnormal discharges on the ipsilateral region widely in 11 cases, ipsilateral temporal region in 6 cases, ipsilateral frontal region in 3 cases, contralateral prefronal region in 1 case. Eighteen patientshad implanted intracranial electrodes, including 13 cases with subdural grids and 5 cases with stereotactic electrodes, which had found abnormal discharge originating form insular lobe in 5 cases, perisylvian cortex in 13 cases. Postoperatively, fifteen patients have been followed up more than one year, Engel class I in nine cases, Engel class II in two cases, Engel class III in one case, Engel class IV in three cases; Four patients have been followed up within one year, three paitents have been seizure-free and 1 patient’s seizure frequency has reduced apparently(>90%), four patients were lost to follow up. One patient had intracranial infection after surgery, one had homonymous hemianopsia on the opposite side, and one had transient hemiparesis of contralateral hand.Conclusions:Patients of insular and perisylvian epilepsy kept conscious during seizures, and ictal symptoms tend to occur at night. Somatosensory, viscero-sensory, vegetative, auditory and taste auras would be found before seizures. And viscerosensory and vegetative symptoms tend to be related to integrated motor symptoms, while somatosensory and auditory auras tend to be related to elementary motor symptoms. MRI and MEG have lateralization and localization significance on insular and perisylvian epilepsy.Intracranial electroencephalograph is a precisely localizing method of insular and perisylvian epilepsy. Resection of insular and perisylvian epileptic focus through trans-opercular approach is safe and effective. |
