Surgical Aspects of Opercular Epilepsies

Area of Science:

• Neurosurgery
• Epileptology
• Neuroanatomy

Background:

• Operculoinsular epilepsy poses diagnostic and surgical difficulties due to complex anatomy and proximity to critical brain structures.
• Accurate localization of seizure onset is crucial for effective treatment.

Purpose of the Study:

• To review the surgical anatomy of the opercula and insula.
• To discuss diagnostic and surgical strategies for operculoinsular epilepsy.
• To evaluate outcomes of different surgical approaches.

Main Methods:

• Detailed seizure semiology analysis.
• High-resolution structural and functional neuroimaging.
• Invasive monitoring, including stereoelectroencephalography (SEEG).
• Intraoperative electrocorticography and functional mapping.
• Microsurgical resection and stereotactic laser interstitial thermal therapy (LITT).

Main Results:

• Resective surgery achieves 60-70% seizure freedom.
• Laser interstitial thermal therapy (LITT) offers approximately 50% seizure freedom.
• Both approaches demonstrate relatively safe complication profiles when meticulously planned and executed.

Conclusions:

• Optimal surgical management requires a deep understanding of anatomy, careful patient selection, and advanced mapping technologies.
• Advances in techniques enhance safety and precision for treating operculoinsular epilepsy.
• Tailored surgical strategies minimize risks to critical neurovascular and eloquent cortical structures.