sEEG is a Safe Procedure for a Comprehensive Anatomic Exploration of the Insula: A Retrospective Study of 108 Procedures Representing 254 Transopercular Insular Electrodes

Salado, Anne Laure; Koessler, Laurent; Mijolla, Gabriel De; Schmitt, Emmanuelle; Vignal, Jean–Pierre; Civit, T.; Tyvaert, Louise; Jonas, Jacques; Maillard, Louis; Colnat-Coulbois, Sophie

doi:10.1093/ons/opx106

Cited by 43 publications

(36 citation statements)

References 31 publications

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“…The patient was stereotactically implanted with three multicontact intracerebral electrodes targeting the right ventral OT cortex, according to a well‐defined and previously described procedure (Jonas et al, ; Salado et al, ). Each intracerebral electrode consisted of a cylinder of 0.8 mm diameter and contained 8–11 independent recording contacts of 2 mm in length separated by 1.5 mm from edge to edge and by 3.5 mm center to center.…”

Section: Methodsmentioning

confidence: 99%

The inferior occipital gyrus is a major cortical source of the face‐evoked N170: Evidence from simultaneous scalp and intracerebral human recordings

Jacques

Jonas

Maillard

et al. 2018

Human Brain Mapping

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The sudden onset of a face image leads to a prominent face-selective response in human scalp electroencephalographic (EEG) recordings, peaking 170 ms after stimulus onset at occipitotemporal (OT) scalp sites: the N170 (or M170 in magnetoencephalography). According to a widely held view, the main cortical source of the N170 lies in the fusiform gyrus (FG), whereas the posteriorly located inferior occipital gyrus (IOG) would rather generate earlier face-selective responses. Here, we report neural responses to upright and inverted faces recorded in a unique patient using multicontact intracerebral electrodes implanted in the right IOG and in the OT sulcus above the right lateral FG (LFG). Simultaneous EEG recordings on the scalp identified the N170 over the right OT scalp region. The latency and amplitude of this scalp N170 were correlated at the single-trial level with the N170 recorded in the lateral IOG, close to the scalp lateral occipital surface. In addition, a positive component maximal around the latency of the N170 (a P170) was prominent above the internal LFG, whereas this region typically generates an N170 (or "N200") over its external/ventral surface. This suggests that electrophysiological responses in the LFG manifest as an equivalent dipole oriented mostly along the vertical axis with likely minimal projection to the lateral OT scalp region. Altogether, these observations provide evidence that the IOG is a major cortical generator of the face-selective scalp N170, qualifying the potential contribution of the FG and questioning a strict serial spatiotemporal organization of the human cortical face network.

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Section: Methodsmentioning

confidence: 99%

The inferior occipital gyrus is a major cortical source of the face‐evoked N170: Evidence from simultaneous scalp and intracerebral human recordings

Jacques

Jonas

Maillard

et al. 2018

Human Brain Mapping

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“…There were 12 studies 15-26 that reported on epilepsy duration, with no significant difference between SEEG patients (mean = 126.8 months ± 65.0, median = 121.8) and SDE patients (mean = 62.4 months ± 51.1, median = 51.4; Table 2). Among the SEEG patients, the etiology was identified as a temporal epileptogenic focus in 42.2% of patients, 15,22,23,[26][27][28][29] tumor in 6.7% of patients, 22,23,27,28,30 FCD1 in 39.2% of patients, 16,23,27,28,[31][32][33] FCD2 in 10.7% of patients, 23,28,31 and lesional in 41.5% of patients. [15][16][17]22,23,[28][29][30][31]34 Among the SDE patients, the etiology was identified as a temporal epileptogenic focus in 40.9% of patients, 18,21,25,[35][36][37][38][39][40][41][42][43][44][45...…”

Section: Cohort Descriptionmentioning

confidence: 99%

Method of invasive monitoring in epilepsy surgery and seizure freedom and morbidity: A systematic review

et al. 2019

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Objective Invasive monitoring is sometimes necessary to guide resective surgery in epilepsy patients, but the ideal method is unknown. In this systematic review, we assess the association of postresection seizure freedom and adverse events in stereoelectroencephalography (SEEG) and subdural electrodes (SDE). Methods We searched three electronic databases (MEDLINE, Embase, and CENTRAL [Cochrane Central Register of Controlled Trials]) from their inception to January 2018 with the keywords “electroencephalography,” “intracranial grid,” and “epilepsy.” Studies that presented primary quantitative patient data for postresection seizure freedom with at least 1 year of follow‐up or complication rates of SEEG‐ or SDE‐monitored patients were included. Two trained investigators independently collected data from eligible studies. Weighted mean differences (WMDs) with 95% confidence interval (CIs) were used as a measure of the association of SEEG or SDE with seizure freedom and with adverse event outcomes. Results Of 11 462 screened records, 48 studies met inclusion criteria. These studies reported on 1973 SEEG patients and 2036 SDE patients. Our systematic review revealed SEEG was associated with 61.0% and SDE was associated with 56.4% seizure freedom after resection (WMD = +5.8%, 95% CI = 4.7‐6.9%, P = .001). Furthermore, SEEG was associated with 4.8% and SDE was associated with 15.5% morbidity (WMD = −10.6%, 95% CI = −11.6 to −9.6%, P = .001). SEEG was associated with 0.2% mortality and SDE was associated with 0.4% mortality (WMD = −0.2%, 95% CI = −0.3 to −0.1%, P = .001). Significance In this systematic review of SEEG and SDE invasive monitoring techniques, SEEG was associated with fewer surgical resections yet better seizure freedom outcomes in those undergoing resections. SEEG was also associated with lower mortality and morbidity than SDE. Clinical studies directly comparing these modalities are necessary to understand the relative rates of seizure freedom, morbidity, and mortality associated with these techniques.

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“…Increasing interest in insular epilepsy has emerged during the past decade from studies based on stereo-electroencephalography (SEEG) methodology. [1][2][3][4][5][6][7] SEEG techniques for implanting the insula safely have been developed, [8][9][10][11][12][13] and there is growing evidence that SEEG is particularly effective in demonstrating insular seizure onset. [14][15][16] However, the insula lies deep in the sylvian fissure, covered by eloquent frontal, temporal, and parietal opercula with a dense network of vessels.…”

Section: Introductionmentioning

confidence: 99%

Stereotactic thermocoagulation for insular epilepsy: Lessons from successes and failures

et al. 2019

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Objective To assess factors associated with favorable outcome in refractory insular epilepsy treated by volume‐based stereotactic radiofrequency thermocoagulation (RFTC). Methods We performed volume‐based RFTC in 19 patients (11 males, 7‐44 years old). The volume for thermocoagulation was identified by multimodal data including electroencephalography (EEG)‐video, magnetic resonance imaging (MRI), and fluorodeoxyglucose–positron emission tomography (PET) in all patients, and epileptogenic zone (EZ) was assessed by stereo‐electroencephalography (SEEG) in 16. MRI showed insular lesions in four patients (benign tumors, n = 2; focal cortical dysplasia [FCD], n = 1; polymicrogyria, n = 1). MRI was negative in 15 cases; however, PET was positive in 18, and FCD pattern was detected by SEEG in nine cases. The dominant hemisphere was involved in 12 cases. RFTC was performed as a separate procedure after SEEG, or as a single MRI‐guided procedure. The insular volume to be coagulated was determined by a tridimensional identification of the epileptogenic cortex using MRI, PET, and SEEG, and was destroyed with coalescent thermal lesions. Results Seizure‐free outcome was achieved in 10 patients (53%), including Engel class IA in three (follow‐up = 1‐12 years, mean = 5.4). The responder rate (including Engel classes I‐III) was 89%. Transient postoperative deficits (mild hemiparesia, dysarthria, hypoesthesia, dysgeusia) were observed in eight patients (42%), with rapid and total recovery in all but one with persistent mild dysarthria. Neurological deficits were related to higher number of RFTC procedures (P = .036) and greater volume of RFTC (P = .028). Neuropsychological status was unchanged or improved in all; however, psychiatric status transitorily worsened in three patients. Factors contributing to seizure‐free outcome were the detection of FCD pattern (P = .009), localized EZ (P = .038), low RFTC volume (P = .002), low number of RFTC procedures (P = .001), and low RFTC volume/number ratio (P = .012). Optimal volume of RFTC around 2 cm3 offered the best compromise between efficacy and safety. Significance RFTC may be curative in insular epilepsy after accurate localization of EZ with SEEG. Best outcome was associated with low volume of thermolesions.

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sEEG is a Safe Procedure for a Comprehensive Anatomic Exploration of the Insula: A Retrospective Study of 108 Procedures Representing 254 Transopercular Insular Electrodes

Abstract: In the presurgical evaluation of drug-resistant epilepsy, the insular cortex can be explored safely and comprehensively using transopercular sEEG electrodes. Parasagittal oblique trajectories may also be associated to achieve an optimal exploration.

Cited by 43 publications

References 31 publications

The inferior occipital gyrus is a major cortical source of the face‐evoked N170: Evidence from simultaneous scalp and intracerebral human recordings

The inferior occipital gyrus is a major cortical source of the face‐evoked N170: Evidence from simultaneous scalp and intracerebral human recordings

Method of invasive monitoring in epilepsy surgery and seizure freedom and morbidity: A systematic review

Stereotactic thermocoagulation for insular epilepsy: Lessons from successes and failures

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