Depth Electrode Guided Anterior Insulectomy: 2-Dimensional Operative Video

Area of Science:

• Neurosurgery
• Epileptology
• Neurophysiology

Background:

• The insula is a known epileptogenic zone, making its surgical treatment complex.
• Insular epilepsy surgery requires precise anatomical knowledge and careful neuromonitoring.
• Non-invasive evaluations can sometimes yield discordant results in localizing the seizure onset zone.

Purpose of the Study:

• To illustrate an intracranial electroencephalogram (EEG) depth electrode-guided anterior insulectomy procedure.
• To demonstrate the safety and efficacy of this technique in a patient with medically refractory epilepsy.

Main Methods:

• A 17-year-old female with refractory epilepsy underwent intracranial EEG monitoring with a comprehensive electrode placement.
• Depth electrodes precisely localized the epileptogenic focus within the anterior insula.
• A right anterior insulectomy was performed, with depth electrode guidance refining resection margins due to neuronavigation brain shift.

Main Results:

• Intracranial EEG identified epileptiform activity originating from the anterior insula.
• The depth electrode-guided anterior insulectomy was successfully performed.
• The patient experienced no neurological deficits post-surgery and remained seizure-free at discharge.

Conclusions:

• Depth electrode-guided insular surgery is a safe and precise method for treating epilepsy originating in the insula.
• This technique allows for tailored removal of the epileptic zone, achieving optimal outcomes.
• It provides a reliable alternative when neuronavigation is compromised by brain shift.