Operculoinsular cortectomy for refractory epilepsy. Part 2: Is it safe?

Area of Science:

• Neurosurgery
• Epileptology
• Neurology

Background:

• Operculoinsular cortectomy is a recognized treatment for perisylvian refractory epilepsy.
• Neurosurgeons hesitate due to potential neurological complications.
• Quantifying complications and identifying predictive factors is crucial.

Purpose of the Study:

• To quantify the incidence of basic neurological complications after operculoinsular cortectomy.
• To identify factors predicting these complications in refractory epilepsy patients.

Main Methods:

• Retrospective review of clinical, imaging, and surgical data.
• Exclusion of patients with tumors or encephalitis.
• Logistic regression for statistical analysis.

Main Results:

• 54.5% of procedures had temporary deficits; only 2.3% had permanent deficits.
• Permanent deficits were mainly due to resection beyond the target area.
• Preoperative insular hypometabolism predicted overall neurological deficits.

Conclusions:

• Operculoinsular cortectomy is relatively safe, with temporary deficits being frequent but permanent ones rare.
• Resection of frontal/parietal opercula impacts complications; corona radiata lesions are not clearly linked to motor deficits.
• Low complication rates are achievable with microsurgical techniques, precise resection, and experienced surgeons.