Invasive Insular Sampling in Pediatric Epilepsy: A Single-Institution Experience

Area of Science:

• Pediatric epilepsy surgery
• Neurosurgery
• Epileptology

Background:

• The insular cortex is crucial in pediatric frontotemporal-parietal epilepsy.
• Conventional methods struggle to accurately assess the insula's role in seizures.
• Stereotactic insular depth electrode placement offers direct, low-risk monitoring.

Purpose of the Study:

• To report the largest series of pediatric patients undergoing insular depth electrode placement.
• To evaluate the efficacy and safety of this invasive monitoring technique.

Main Methods:

• Retrospective review of clinical data from patients who underwent insular depth electrode insertion.
• Identification of cases using Current Procedural Terminology billing records.
• Multidisciplinary epilepsy team determined electrode placement.

Main Results:

• Seventy-four electrodes were placed in 49 pediatric patients for extraoperative monitoring.
• In 65.3% of cases, insular involvement in seizure onset was confirmed, leading to thermoablation or resection.
• No serious adverse events were associated with insular depth electrode placement.

Conclusions:

• Insular depth electrode insertion has low morbidity and high diagnostic yield in pediatric epilepsy.
• This technique should be considered for the standard presurgical evaluation of refractory epilepsy.
• Direct insular monitoring aids in treatment decisions for refractory frontotemporal-parietal epilepsy.