title: Insular epilepsy surgery.
abstract: Since it was originally described nearly 70 years ago, insular epilepsy has been increasingly recognized and may explain failures after apparently well-planned operations. We review the history of awareness of the phenomenon, techniques for its assessment, and its surgical management. Insular epilepsy can mimic features of frontal, parietal, or temporal seizures. It should be considered when a combination of somatosensory, visceral, and motor symptoms is observed early in a seizure. Extraoperative intracranial recordings are required to accurately diagnose insular seizures. Stereo-electroencephalography (EEG) or craniotomy with implantation of surface and depth electrodes have been used successfully to identify insular onset of seizures. Surgical resection of an insular focus may be performed with good success and acceptable risk.
authors.affiliation: Division of Neurology, Department of Pediatrics, University of Colorado Denver School of Medicine and Children's Hospital Colorado, Aurora, Colorado, U.S.A.
authors.forename: Pramote
authors.initials: P
authors.lastname: Laoprasert
authors.affiliation: Department of Neurosurgery, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, Washington, U.S.A.
authors.forename: Jeffrey G
authors.initials: JG
authors.lastname: Ojemann
authors.affiliation: Department of Neurosurgery, University of Colorado Denver School of Medicine and Children's Hospital Colorado, Aurora, Colorado, U.S.A.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Handler
mesh_terms: D002540:Cerebral Cortex / Q000601:surgery*; D004567:Electrodes, Implanted; D004569:Electroencephalography; D004827:Epilepsy / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D019635:Neurosurgical Procedures / Q000379:methods*
keywords: Insular epilepsy; Insular epilepsy surgery; Temporal lobe plus epilepsy