Stereoelectroencephalography-guided surgical treatment for patients with temporal-insular type of temporal plus epilepsy

Abstract

Objective To investigate the effectiveness and safety of stereoelectroencephalography (SEEG) in guiding surgical treatment of temporal-insular type of temporal plus epilepsy (TI-TPE). Methods A retrospective analysis was conducted on the clinical data of 10 TI-TPE cases confirmed by SEEG from May 2014 to November 2015 at Department of Epilepsy Center, Guangdong Sanjiu Brain Hospital. Those 10 patients accounted for 6.8% of 147 surgical cases of temporal lobe epilepsy treated during the same period. Electrodes were implanted in all cases with the assistance of neurosurgical stereotactic robot. The epileptogenic zone, including the anterior temporal lobe, mesial temporal lobe and epileptic insular cortex, were surgically resected with SEEG guidance. The outcome was assessed to explore the effectiveness of operation. Results The number of electrodes implanted in each case was 9-16 (12.4±2.1) on average. Based on the SEEG results, 7 cases were classified as simultaneous type and 3 as independent type. All cases underwent surgical operations. No complication was observed in this series except for 1 who had transient naming aphasia and recovered before discharge. As indicated by clinical follow-up of 18-36 (28±6) months on average, all cases reached Engel class I post operation (9 cases of Ia and 1 of Ic). Conclusion SEEG is a significant method for the diagnosis of TI-TPE. For TI-TPE cases, surgical treatment with the guidance of SEEG seems safe and effective. Key words: Neurosurgical procedures; Epilepsy, temporal lobe; Epilepsy, insular lobe; Temporal plus epilepsy; Stereoelectroecephalography