Operculoinsular cortectomy for refractory epilepsy. Part 1: Is it effective?

Area of Science:

• Neurosurgery
• Epileptology
• Clinical Neurology

Background:

• Refractory epilepsy of operculoinsular origin often lacks effective surgical options due to feared complications.
• Limited surgical series with significant case numbers documenting seizure control outcomes hinder treatment.
• Operculoinsular cortectomy (operculoinsulectomy) is a specialized surgical technique.

Purpose of the Study:

• To document seizure control outcomes after operculoinsular cortectomy.
• To evaluate the efficacy of this technique in patients treated by an experienced epilepsy team.
• To identify predictors of seizure control after operculoinsular cortectomy.

Main Methods:

• Retrospective review of clinical, imaging, surgical, and seizure control data.
• Exclusion of tumor and progressive encephalitis cases.
• Descriptive, uni-, and multivariate analyses to determine outcomes and predictors.

Main Results:

• 70.2% seizure freedom at 1 year, 76.9% Engel Class I outcome with >1 year follow-up (mean 5.8 years).
• Unfavorable predictors included frontal lobe-like seizure semiology, shorter epilepsy duration, and invasive monitoring.
• Recurrent seizures linked to incomplete resection, bilateral epilepsy, or residual epileptic cortex.

Conclusions:

• Operculoinsular cortectomy is effective for refractory epilepsy, comparable to other brain area surgeries.
• Patients should be referred to experienced centers for this specialized epilepsy surgery.
• Complete resection of the epileptic zone is vital for successful seizure control.