Robot-assisted insular stereoelectroencephalography in pediatric drug-resistant epilepsy: accuracy and diagnostic value

BackgroundInsular epilepsy is a well-known cause of drug-resistant epilepsy (DRE) in the pediatric population. It can be a source of surgical epilepsy treatment failures when not ruled out pre-operatively. Non-invasive methods often provide limited information about its existence, being the invasive...

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Autores: González-Crespo A, Brugada-Bellsolà F, Candela-Cantó S, Calvo JA, Arboix JR, Bernal JH
Tipo de documento: artigo
Estado:Versão publicada
Data de publicação:2024
País:España
Recursos:Fundació Sant Joan de Déu
Repositório:r-FSJD. Repositorio Institucional de Producción Científica de la Fundació Sant Joan de Déu
OAI Identifier:oai:fsjd.fundanetsuite.com:p26806
Acesso em linha:https://fsjd.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=26806
Access Level:Acceso aberto
Palavra-chave:Pediatric epilepsy surgery
Insular epilepsy
Insular SEEG
Pediatric SEEG
Robot-assisted SEEG
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spelling Robot-assisted insular stereoelectroencephalography in pediatric drug-resistant epilepsy: accuracy and diagnostic valueGonzález-Crespo ABrugada-Bellsolà FCandela-Cantó SCalvo JAArboix JRBernal JHPediatric epilepsy surgeryInsular epilepsyInsular SEEGPediatric SEEGRobot-assisted SEEGBackgroundInsular epilepsy is a well-known cause of drug-resistant epilepsy (DRE) in the pediatric population. It can be a source of surgical epilepsy treatment failures when not ruled out pre-operatively. Non-invasive methods often provide limited information about its existence, being the invasive methods necessary to diagnose it in the vast majority of cases. The most used is stereoelectroencephalography (SEEG). We report a series of DRE pediatric patients in which insular SEEG was performed to rule out insular epilepsy.MethodWe performed a retrospective review of pediatric DRE patients operated on SEEG including insular electrodes between April 2016 and September 2022. We described the different trajectories used (orthogonal or oblique) and surgical techniques. After implantation, we assessed electrodes' precision using three measures: entry point location error (EPLE), target point location error (TPLE), and target deviation (TD). We also reported complications that occurred with this technique as well as the diagnostic information provided.ResultsOverall, 32 DRE patients were operated on SEEG including insular electrodes. Four hundred one electrodes were implanted, 148 (39.91%) of whom were directed to the insula. One hundred twelve followed an orthogonal trajectory, and 36 were oblique. The mean EPLE was 1.45 mm, TPLE was 1.88 mm and TD was 0.71 mm. Three patients suffered from frontal hematoma, two of them diagnosed on post-operative MRI and one who required surgery, with no sequelae. One patient suffered from meningitis treated with antibiotics with no permanent sequelae. Nine patients (28.13%) had the insula included in the epileptogenic zone.ConclusionsInsular epilepsy has to be ruled out in DRE patients when little suspicion is obtained after non-invasive testing. This is especially important in the pediatric population, in which seizure semiology is more difficult to characterize and failures to control epilepsy have devastating consequences in neurocognitive development and scholarship. Given its relative low rate of relevant complications and potential benefits, we should consider widening the inclusion criteria for insular SEEG monitoring.SPRINGER2024info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttps://fsjd.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=26806CHILDS NERVOUS SYSTEMISSN: 02567040ISSNe: 14330350reponame:r-FSJD. Repositorio Institucional de Producción Científica de la Fundació Sant Joan de Déuinstname:Fundació Sant Joan de DéuInglésinfo:eu-repo/semantics/openAccessoai:fsjd.fundanetsuite.com:p268062026-05-27T12:37:41Z
dc.title.none.fl_str_mv Robot-assisted insular stereoelectroencephalography in pediatric drug-resistant epilepsy: accuracy and diagnostic value
title Robot-assisted insular stereoelectroencephalography in pediatric drug-resistant epilepsy: accuracy and diagnostic value
spellingShingle Robot-assisted insular stereoelectroencephalography in pediatric drug-resistant epilepsy: accuracy and diagnostic value
González-Crespo A
Pediatric epilepsy surgery
Insular epilepsy
Insular SEEG
Pediatric SEEG
Robot-assisted SEEG
title_short Robot-assisted insular stereoelectroencephalography in pediatric drug-resistant epilepsy: accuracy and diagnostic value
title_full Robot-assisted insular stereoelectroencephalography in pediatric drug-resistant epilepsy: accuracy and diagnostic value
title_fullStr Robot-assisted insular stereoelectroencephalography in pediatric drug-resistant epilepsy: accuracy and diagnostic value
title_full_unstemmed Robot-assisted insular stereoelectroencephalography in pediatric drug-resistant epilepsy: accuracy and diagnostic value
title_sort Robot-assisted insular stereoelectroencephalography in pediatric drug-resistant epilepsy: accuracy and diagnostic value
dc.creator.none.fl_str_mv González-Crespo A
Brugada-Bellsolà F
Candela-Cantó S
Calvo JA
Arboix JR
Bernal JH
author González-Crespo A
author_facet González-Crespo A
Brugada-Bellsolà F
Candela-Cantó S
Calvo JA
Arboix JR
Bernal JH
author_role author
author2 Brugada-Bellsolà F
Candela-Cantó S
Calvo JA
Arboix JR
Bernal JH
author2_role author
author
author
author
author
dc.subject.none.fl_str_mv Pediatric epilepsy surgery
Insular epilepsy
Insular SEEG
Pediatric SEEG
Robot-assisted SEEG
topic Pediatric epilepsy surgery
Insular epilepsy
Insular SEEG
Pediatric SEEG
Robot-assisted SEEG
description BackgroundInsular epilepsy is a well-known cause of drug-resistant epilepsy (DRE) in the pediatric population. It can be a source of surgical epilepsy treatment failures when not ruled out pre-operatively. Non-invasive methods often provide limited information about its existence, being the invasive methods necessary to diagnose it in the vast majority of cases. The most used is stereoelectroencephalography (SEEG). We report a series of DRE pediatric patients in which insular SEEG was performed to rule out insular epilepsy.MethodWe performed a retrospective review of pediatric DRE patients operated on SEEG including insular electrodes between April 2016 and September 2022. We described the different trajectories used (orthogonal or oblique) and surgical techniques. After implantation, we assessed electrodes' precision using three measures: entry point location error (EPLE), target point location error (TPLE), and target deviation (TD). We also reported complications that occurred with this technique as well as the diagnostic information provided.ResultsOverall, 32 DRE patients were operated on SEEG including insular electrodes. Four hundred one electrodes were implanted, 148 (39.91%) of whom were directed to the insula. One hundred twelve followed an orthogonal trajectory, and 36 were oblique. The mean EPLE was 1.45 mm, TPLE was 1.88 mm and TD was 0.71 mm. Three patients suffered from frontal hematoma, two of them diagnosed on post-operative MRI and one who required surgery, with no sequelae. One patient suffered from meningitis treated with antibiotics with no permanent sequelae. Nine patients (28.13%) had the insula included in the epileptogenic zone.ConclusionsInsular epilepsy has to be ruled out in DRE patients when little suspicion is obtained after non-invasive testing. This is especially important in the pediatric population, in which seizure semiology is more difficult to characterize and failures to control epilepsy have devastating consequences in neurocognitive development and scholarship. Given its relative low rate of relevant complications and potential benefits, we should consider widening the inclusion criteria for insular SEEG monitoring.
publishDate 2024
dc.date.none.fl_str_mv 2024
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
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dc.identifier.none.fl_str_mv https://fsjd.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=26806
url https://fsjd.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=26806
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv SPRINGER
publisher.none.fl_str_mv SPRINGER
dc.source.none.fl_str_mv CHILDS NERVOUS SYSTEM
ISSN: 02567040
ISSNe: 14330350
reponame:r-FSJD. Repositorio Institucional de Producción Científica de la Fundació Sant Joan de Déu
instname:Fundació Sant Joan de Déu
instname_str Fundació Sant Joan de Déu
reponame_str r-FSJD. Repositorio Institucional de Producción Científica de la Fundació Sant Joan de Déu
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