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Pepper J, Cuthbert H, Scott T, Ughratdar I, Wykes V, Watts C, D'Urso P, Karabatsou K, Moor CC, Albanese E. Seizure Outcome After Surgery for Insular High-Grade Glioma. World Neurosurg 2021; 154:e718-e723. [PMID: 34343689 DOI: 10.1016/j.wneu.2021.07.114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 07/26/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The insular cortex is an eloquent island of mesocortex surrounded by vital structures making this region relatively challenging to neurosurgeons. Historically, lesions in this region were considered too high risk to approach given the strong chance of poor surgical outcome. Advances in recent decades have meant that surgeons can more safely access this eloquent region. Seizure outcome after excision of insular low-grade gliomas is well reported, but little is known about seizure outcomes after excision of insular high-grade gliomas. METHODS A retrospective analysis was performed of all patients presenting with new-onset seizures during 2015-2019 who underwent excision of an insular high-grade glioma at 3 regional neurosurgical centers in the United Kingdom. RESULTS We identified 38 patients with a mean (SD) age of 45.7 (15.3) years with median follow-up of 21 months. At long-term follow-up, of 38 patients, 23 were seizure-free (Engel class I), 2 had improved seizures (Engel class II), 6 had poor seizure control (Engel class III/IV), and 7 died. CONCLUSIONS Excision of insular high-grade gliomas is safe and results in excellent postoperative seizure control.
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Affiliation(s)
- Joshua Pepper
- Department of Neurosurgery, University Hospital of North Midlands, Stoke on Trent, United Kingdom.
| | - Hadleigh Cuthbert
- Department of Neurosurgery, University Hospital of North Midlands, Stoke on Trent, United Kingdom
| | - Teresa Scott
- Department of Neurosurgery, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Ismail Ughratdar
- Department of Neurosurgery, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Victoria Wykes
- Department of Neurosurgery, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Colin Watts
- Department of Neurosurgery, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Pietro D'Urso
- Department of Neurosurgery, Salford Royal Hospital, Salford, United Kingdom
| | | | - Carl-Christian Moor
- Department of Neurology, University Hospital of North Midlands, Stoke on Trent, United Kingdom
| | - Erminia Albanese
- Department of Neurosurgery, University Hospital of North Midlands, Stoke on Trent, United Kingdom
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Asimakidou E, Abut PA, Raabe A, Seidel K. Motor Evoked Potential Warning Criteria in Supratentorial Surgery: A Scoping Review. Cancers (Basel) 2021; 13:2803. [PMID: 34199853 PMCID: PMC8200078 DOI: 10.3390/cancers13112803] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/30/2021] [Accepted: 05/31/2021] [Indexed: 12/31/2022] Open
Abstract
During intraoperative monitoring of motor evoked potentials (MEP), heterogeneity across studies in terms of study populations, intraoperative settings, applied warning criteria, and outcome reporting exists. A scoping review of MEP warning criteria in supratentorial surgery was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Sixty-eight studies fulfilled the eligibility criteria. The most commonly used alarm criteria were MEP signal loss, which was always a major warning sign, followed by amplitude reduction and threshold elevation. Irreversible MEP alterations were associated with a higher number of transient and persisting motor deficits compared with the reversible changes. In almost all studies, specificity and Negative Predictive Value (NPV) were high, while in most of them, sensitivity and Positive Predictive Value (PPV) were rather low or modest. Thus, the absence of an irreversible alteration may reassure the neurosurgeon that the patient will not suffer a motor deficit in the short-term and long-term follow-up. Further, MEPs perform well as surrogate markers, and reversible MEP deteriorations after successful intervention indicate motor function preservation postoperatively. However, in future studies, a consensus regarding the definitions of MEP alteration, critical duration of alterations, and outcome reporting should be determined.
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Affiliation(s)
- Evridiki Asimakidou
- Department of Neurosurgery, Inselspital, Bern University Hospital, 3010 Bern, Switzerland; (E.A.); (P.A.A.); (A.R.)
| | - Pablo Alvarez Abut
- Department of Neurosurgery, Inselspital, Bern University Hospital, 3010 Bern, Switzerland; (E.A.); (P.A.A.); (A.R.)
- Department of Neurosurgery, Clínica 25 de Mayo, 7600 Mar del Plata, Argentina
| | - Andreas Raabe
- Department of Neurosurgery, Inselspital, Bern University Hospital, 3010 Bern, Switzerland; (E.A.); (P.A.A.); (A.R.)
| | - Kathleen Seidel
- Department of Neurosurgery, Inselspital, Bern University Hospital, 3010 Bern, Switzerland; (E.A.); (P.A.A.); (A.R.)
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Wang DD, Deng H, Hervey-Jumper SL, Molinaro AA, Chang EF, Berger MS. Seizure Outcome After Surgical Resection of Insular Glioma. Neurosurgery 2019; 83:709-718. [PMID: 29126238 DOI: 10.1093/neuros/nyx486] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 08/31/2017] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND A majority of patients with insular tumors present with seizures. Although a number of studies have shown that greater extent of resection improves overall patient survival, few studies have documented postoperative seizure control after insular tumor resection. OBJECTIVE To (1) characterize seizure control rates in patients undergoing insular tumor resection, (2) identify predictors of seizure control, and (3) evaluate the association between seizure recurrence and tumor progression. METHODS The study population included adults who had undergone resection of insular gliomas between 1997 and 2015 at our institution. Preoperative seizure characteristics, tumor characteristics, surgical factors, and postoperative seizure outcomes were reviewed. RESULTS One-hundred nine patients with sufficient clinical data were included in the study. At 1 yr after surgery, 74 patients (68%) were seizure free. At final follow-up, 42 patients (39%) were seizure free. Median time to seizure recurrence was 46 mo (95% confidence interval 31-65 mo). Multivariate Cox regression analysis revealed that greater extent of resection (hazard ratio = 0.2899 [0.1129, 0.7973], P = .0127) was a significant predictor of seizure freedom. Of patients who had seizure recurrence and tumor progression, seizure usually recurred within 3 mo prior to tumor progression. Repeat resection offered additional seizure control, as 8 of the 22 patients with recurrent seizures became seizure free after reoperation. CONCLUSION Maximizing the extent of resection in insular gliomas portends greater seizure freedom after surgery. Seizure recurrence is associated with tumor progression, and repeat operation can provide additional seizure control.
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Affiliation(s)
- Doris D Wang
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Hansen Deng
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Shawn L Hervey-Jumper
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Annette A Molinaro
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Edward F Chang
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Mitchel S Berger
- Department of Neurological Surgery, University of California, San Francisco, California
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Jobst BC, Kapur R, Barkley GL, Bazil CW, Berg MJ, Bergey GK, Boggs JG, Cash SS, Cole AJ, Duchowny MS, Duckrow RB, Edwards JC, Eisenschenk S, Fessler AJ, Fountain NB, Geller EB, Goldman AM, Goodman RR, Gross RE, Gwinn RP, Heck C, Herekar AA, Hirsch LJ, King-Stephens D, Labar DR, Marsh WR, Meador KJ, Miller I, Mizrahi EM, Murro AM, Nair DR, Noe KH, Olejniczak PW, Park YD, Rutecki P, Salanova V, Sheth RD, Skidmore C, Smith MC, Spencer DC, Srinivasan S, Tatum W, Van Ness P, Vossler DG, Wharen RE, Worrell GA, Yoshor D, Zimmerman RS, Skarpaas TL, Morrell MJ. Brain-responsive neurostimulation in patients with medically intractable seizures arising from eloquent and other neocortical areas. Epilepsia 2017; 58:1005-1014. [DOI: 10.1111/epi.13739] [Citation(s) in RCA: 148] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Barbara C. Jobst
- Geisel School of Medicine at Dartmouth; Hanover New Hampshire U.S.A
| | - Ritu Kapur
- NeuroPace, Inc.; Mountain View California U.S.A
| | | | - Carl W. Bazil
- Columbia University Medical Center; New York New York U.S.A
| | - Michel J. Berg
- University of Rochester Medical Center; Rochester New York U.S.A
| | | | - Jane G. Boggs
- Wake Forest University Health Sciences; Winston-Salem North Carolina U.S.A
| | - Sydney S. Cash
- Massachusetts General Hospital; Boston Massachusetts U.S.A
| | - Andrew J. Cole
- Massachusetts General Hospital; Boston Massachusetts U.S.A
| | - Michael S. Duchowny
- Miami Children's Hospital / Nicklaus Children's Hospital; Miami Florida U.S.A
| | | | | | | | - A. James Fessler
- University of Rochester Medical Center; Rochester New York U.S.A
| | - Nathan B. Fountain
- University of Virginia School of Medicine; Charlottesville Virginia U.S.A
| | - Eric B. Geller
- Institute of Neurology and Neurosurgery at Saint Barnabas; Livingston New Jersey U.S.A
| | | | | | | | - Ryder P. Gwinn
- Swedish Neuroscience Institute; Seattle Washington U.S.A
| | | | | | | | | | | | - W. R. Marsh
- Mayo Clinic Minnesota; Rochester Minnesota U.S.A
| | | | - Ian Miller
- Miami Children's Hospital / Nicklaus Children's Hospital; Miami Florida U.S.A
| | | | | | | | | | | | | | - Paul Rutecki
- University of Wisconsin Hospital and Clinics; Madison Wisconsin U.S.A
| | - Vicenta Salanova
- Indiana University School of Medicine; Indianapolis Indiana U.S.A
| | | | | | | | | | | | - William Tatum
- Mayo Clinic's Campus in Florida; Jacksonville Florida U.S.A
| | | | | | | | | | | | | | | | - Martha J. Morrell
- NeuroPace, Inc.; Mountain View California U.S.A
- Stanford University; Stanford California U.S.A
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Finet P, Nguyen DK, Bouthillier A. Vascular consequences of operculoinsular corticectomy for refractory epilepsy. J Neurosurg 2015; 122:1293-8. [DOI: 10.3171/2014.10.jns141246] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT
Surgery in the insular region is considered challenging because of its vascular relationships, the proximity of functional structures, and its deep location in the sylvian fissure. The authors report the incidence and consequences of ischemic lesions after operculoinsular corticectomy for refractory epilepsy.
METHODS
The authors retrospectively reviewed the data of all patients who underwent an insular resection with or without an opercular resection for refractory epilepsy at their center. All patients underwent postoperative MRI, enabling a radiological analysis of the ischemic lesions as a result of the corticectomies. The resections were classified according to the location and extent of the insular corticectomy and the type of operculectomy. Each patient underwent clinical follow-up.
RESULTS
Twenty patients underwent surgery. All patients underwent insular corticectomy with or without an operculectomy. Ischemic lesions were identified in 12 patients (60%). In these patients, 11 ischemic lesions (55%) were related to the insular corticectomy, and 1 was related to the associated periinsular resection. The ischemic lesions associated with the insulectomies were typically located in the corona radiata running from the insula to the periventricular region. Nine patients (45%) developed a postoperative neurological deficit, among whom 6 (67%) had an insular corticectomy–related ischemic lesion. All reported neurological deficits were transient. Five patients (25%) had ischemic lesions without neurological deficit.
CONCLUSIONS
Operculoinsular corticectomies are associated with ischemic lesions in approximately 60% of patients. However, given that no patient had a definitive postoperative deficit, these ischemic lesions have few clinical consequences. Therefore, this surgical procedure can be considered reasonably safe for the treatment of refractory epilepsy.
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Affiliation(s)
| | - Dang Khoa Nguyen
- 2Neurology, University of Montreal Medical Center (CHUM), Montreal, Quebec, Canada
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Intraoperative coregistration of magnetic resonance imaging, positron emission tomography, and electrocorticographic data for neocortical lesional epilepsies may improve the localization of the epileptogenic focus: a pilot study. World Neurosurg 2013; 82:110-7. [PMID: 23438971 DOI: 10.1016/j.wneu.2013.02.057] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2012] [Revised: 02/03/2013] [Accepted: 02/13/2013] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To objectively mark out abnormal areas of magnetic resonance imaging (MRI), positron emission tomography (PET), and electrocorticography (ECoG) using neuronavigation so as to 1) enhance the accuracy of margins of the epileptogenic zone and 2) understand the relationships of all the three modalities with each other. METHODS A prospective study was conducted of 37 patients with intractable epilepsy due to lesional, neocortical pathologies from noneloquent areas. Prior to surgery, fusion and transfer of MRI and PET images onto a neuronavigation system was performed. At surgery, this was correlated to intraoperative ECoG using the electrode as referential points. An objective score was created for every electrode point that was correlated with MRI and PET abnormality at the point. The extent of surgical resection was mapped out using these data. RESULTS From a total of the data recorded from 1280 electrode points, 23.5% were located over the lesion. In addition, over the lesions, 93% of PET and 66% of ECoG points were abnormal. Over the perilesional areas, 43% of PET and 45% of ECoG points were abnormal. Using these data for surgery, both lesional and perileisonal areas were resected; 33/37 patients had good outcome (25 Engel I, 8 Engel II) (mean follow-up: 23.6 ± 3.2 months; range 18-31 months). CONCLUSION Multimodal imaging and ECoG using this method seems to provide a better objective localization of the epileptogenic foci.
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Dionisio S, Koenig A, Murray J, Somerville E. A gut feeling about insular seizures. BMJ Case Rep 2011; 2011:bcr.12.2010.3647. [PMID: 22692493 DOI: 10.1136/bcr.12.2010.3647] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 43-year-old man presented to the Prince of Wales Hospital, Sydney, New South Wales, Australia, after experiencing his first tonic-clonic seizure. For the previous 2 years he had undergone gastroenterological investigation of episodes of gagging associated with hypersalivation and lachrymation, occurring three or four times per week. EEG showed epileptiform discharges in the right anterior temporal region; brain MRI revealed a lesion in the right insular cortex. Video-EEG telemetry demonstrated that the episodes of gagging were focal seizures. Antiepileptic drug therapy resulted in no further episodes occurring over the next 10 months.
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Affiliation(s)
- S Dionisio
- Comprehensive Epilepsy Service, Prince of Wales Hospital, Randwick, Sydney, New South Wales, Australia.
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