title: Vascular consequences of operculoinsular corticectomy for refractory epilepsy.
abstract: OBJECTIVE
  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.
authors: Divisions of 1Neurosurgery and.
authors: Patrice
authors: P
authors: Finet
authors: 2Neurology, University of Montreal Medical Center (CHUM), Montreal, Quebec, Canada.
authors: Dang Khoa
authors: DK
authors: Nguyen
authors: Divisions of 1Neurosurgery and.
authors: Alain
authors: A
authors: Bouthillier
mesh_terms: D000293:Adolescent; D000328:Adult; D002545:Brain Ischemia / Q000209:etiology* / Q000473:pathology; D002540:Cerebral Cortex / Q000473:pathology / Q000601:surgery*; D004827:Epilepsy / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: ECoG = electrocorticography; EEG = electroencephalography; LLA = lenticulostriate artery; MCA = middle cerebral artery; insula surgery; ischemic lesions; operculoinsular resection; refractory epilepsy