Stereoelectroencephalography (SEEG)-guided insula resections: is it "Reily" worth it?

Area of Science:

• Neurosurgery
• Epileptology
• Pediatric Neurology

Background:

• Stereoelectroencephalography (SEEG) is crucial for mapping epileptic networks in pediatric epilepsy surgery.
• The insula is an increasingly recognized surgical target due to its extensive connectivity.
• This study evaluates outcomes of SEEG-guided insula resections in children.

Purpose of the Study:

• To report seizure outcomes following SEEG-guided insula cortex resection in a pediatric cohort.
• To assess the efficacy and potential challenges of targeting the insula in pediatric epilepsy surgery.

Main Methods:

• Analysis of demographic and clinical data from a pediatric epilepsy surgery database (patients aged 0-19 years).
• Inclusion criteria: patients who underwent SEEG-guided insula cortex resection.
• Data collected included age at first SEEG, age at seizure onset, seizure frequency, number of SEEG recordings, and follow-up duration.

Main Results:

• Eleven children (7 female, 4 male) underwent SEEG-guided insula resection.
• Mean age at first SEEG was 13 years; mean age at seizure onset was 4.3 years.
• At a mean follow-up of 2.1 years, 3 children achieved Engel I, 2 Engel III, and 6 Engel IV seizure outcomes. One Engel IV patient later achieved Engel I after identifying and resecting a focal cortical dysplasia.

Conclusions:

• Approximately one-third of pediatric patients achieved seizure freedom after SEEG-guided insula cortex surgery.
• Outcomes may necessitate repeat SEEG implantation or resective surgery.
• Hypothesis shifts from the insula to adjacent foci may be required for successful treatment.