Analysis Of Localization And Surgical Effect Of Insular Epilepsy With ROSA Assistance

Background:Insular cortex is an uncommon epileptogenic site.Due to its anatomical particularity and symptomatic complexity,symptomatology,scalp electroencephalogram(Scalp-EEG)or other non-invasive methods are not enough to locate insular epileptogenic zone accurately.It is often confused as frontal lobe epilepsy,temporal lobe epilepsy,or parietal lobe epilepsy.Stereoelectroencephalogram(SEEG)assisted by ROSA provides a safe and accurate method for locating the epileptic area of insular lobe accurately and improving the effect of surgical treatment.With the development of neuronavigation system and robot technology,multi-mode and frameless brain deep electrode implantation have been well implemented in adults and children,and the safety,accuracy and effectiveness of ROS A-assisted SEEG have been well confirmed.Objective:(1)to explore the consistency of the symptomatology,non-invasive examination results of insular epilepsy and SEEG data with the assistance of ROSA.And to clarify the accuracy of anatomical-electro-clinical diagnosis and localization of insular epilepsy zone.(2)to explore the surgery effect of refractory epilepsy originating from pure insular confirmed by SEEG,and to accumulate more experience for the surgical treatment of insular epilepsy.Methods:A retrospective study was conducted on 277 patients with medically refractory epilepsy diagnosed and treated in the Epilepsy Center of Shanghai Deji Hospital,Qingdao university from April 2017 to October 2020.According to the inclusion and exclusion criteria,a total of 11 patients with intractable epilepsy originating from pure insular were selected.The general data(age,sex,duration of disease,personal history),symptomatology,V-EEG,MRI,PET-CT,SEEG and follow-up data of these patients were collected.Results:A total of 148(13.45±3.62SD)electrodes were implanted in 11 patients,including 69(6.37±3.00SD)insular electrodes.No electrode-related complications(such as intracranial hemorrhage,electrode failure,intracranial infection,etc.)were found in 11 patients.The epileptic discharge in all patients originated from the insular lobe(including the anterior and posterior wall of circum-insular sulcus)by SEEG monitoring,and the abnormal discharge site was consistent with semiology,imaging and low metabolic area of PET-CT.After locating the epileptic zone according to the results of SEEG,all patients underwent resection of epileptic zone according to individual surgical plans.The follow-up period was 6-40(24±12.57SD)months.Seizure-free(Engel grade Ⅰ)was observed in 9 patients(81.8%),one(9.1%)had only mild seizures(Engel grade Ⅱ),and 1 case(9.1%)still had frequent seizures(Engel gradeⅣ).Histopathological diagnosis:glial hyperplasia in 6 cases(54.55%),focal malacia in 3 cases(27.27%),tuberous sclerosis in 1 case(9.1%),inflammation change in 1 case(9.1%,this patient has the meningitis history).After operation,2 patients(18.18%)expericed contralateral hemiplegia,one(9.1%)had mixed aphasia,1 patient(9.1%)suffered severe vomiting,one(9.1%)had intracranial infection.Except one patient(9.1%)with permanent unilateral limb paresis,all the other cases recovered within 1 month.Conclusion:(1)with the assistance of ROSA,SEEG can locate the origin of abnormal discharge in insular lobe accurately and the anatomical-electrical-clinical consistency was verified.(2)intractable epilepsy of insular origin confirmed by SEEG can be treated by surgery safely,and satisfactory results of epilepsy control can be obtained.