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CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2022; 41(03): e249-e257
DOI: 10.1055/s-0042-1749072
Review Article

Insulectomy for Refractory Epilepsy: Case Series and Literature Review

Insulectomia para epilepsia refratária: Série de casos e revisão de literatura
Adriano de Medeiros Barbosa Rodrigues 
1   Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, SP, Brazil
,
Henrique Nicola Santo Antonio Bernardo 
2   Faculdade de Medicina do ABC, Santo André, SP, Brazil
,
Maria Clara Cardoso Seba 
2   Faculdade de Medicina do ABC, Santo André, SP, Brazil
,
Carlos Alberto de Almeida Castro Junior 
3   Hospital Santa Paula , São Paulo, SP, Brazil
,
Paulo Roberto Franceschini 
4   Universidade de Caxias do Sul, Caxias do Sul, RS, Brazil
,
Paulo Henrique Pires de Aguiar 
5   School of Medicine, Pontifícia Universidade Católica de São Paulo, Sorocaba, Brazil
6   Medicine School, Faculdade de Medicina do ABC, Santo André, SP, Brazil
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Abstract

Surgical resection of the insula (insulectomy) is a procedure used for brain lesions and for refractory epilepsy. It has a difficult surgical access and the need of a wide anatomical knowledge and preoperative planning. There are two types of surgical approaches aiming the exposure of the insular cortex: transsylvian and transcortical. The importance of insulectomies is the efficacy in providing a remarkable decrease in seizures. The objective of the present article is to document the results of a series of 10 patients submitted to insulectomies for refractory epilepsies and compare them with the results of other studies reported in the literature, as well as to describe the main nuances of the surgical approaches and their associated risks. In the new case series, all patients corresponded to preoperative Engel classification IV for; after a mean 2-year follow-up period, they corresponded to Engel classification II. A subtotal resection was performed in six patients, and the remaining four underwent a partial resection, most of them leading to temporary complications. The literature review endorsed the good outcomes of the casuistry. A critical analysis of the presented data reiterates the opinion of several authors that insulectomies are beneficial and safe for the patients. A broad anatomical knowledge of the insular region, preoperative planning (limits of resections), and the use of modern microsurgical techniques must be considered as basic principles by neurosurgeons for the prevention of perioperative morbidities. Insulectomies are safe and effective, although they result in temporary postoperative complications, and provide highly satisfactory results in terms of seizure control.

Resumo

A ressecção cirúrgica da ínsula (insulectomia) é um procedimento utilizado para lesões cerebrais e epilepsia refratária. A ínsula possui um acesso cirúrgico difícil com necessidade de um amplo conhecimento anatômico com planejamento pré-operatório. Existem dois tipos de abordagens cirúrgicas que visam a exposição do córtex insular: transsilvianas e transcorticais. A importância das insulectomias é a eficácia em proporcionar uma diminuição das convulsões. O objetivo do presente artigo é documentar os resultados de uma série de 10 pacientes submetidos a insulectomias para epilepsia refratária e compará-los com os resultados de outros estudos relatados na literatura, além de descrever as principais nuances das abordagens cirúrgicas e os seus riscos associados. Na série de casos, todos os pacientes se enquadravam na classificação pré-operatória de Engel IV e, após um período médio de seguimento de 2 anos, eles se enquadravam na classificação de Engel II. Seis pacientes foram submetidos a uma ressecção subtotal e os quatro restantes a uma ressecção parcial, implicando, majoritariamente, em complicações temporárias. A revisão da literatura endossou os bons resultados da casuística. A análise crítica dos dados apresentados reitera a opinião de vários autores de que as insulectomias são benéficas e seguras para os pacientes. O amplo conhecimento anatômico da região insular, o planejamento pré-operatório (limites das ressecções) e a utilização de técnicas microcirúrgicas modernas devem ser considerados princípios básicos para a prevenção de morbidades perioperatórias. As insulectomias são seguras e eficazes conquanto resultem em complicações pós-operatórias temporárias e proporcionem resultados altamente satisfatórios no que diz respeito ao controle das convulsões.

Keywords

island of reil - insular cortex - refractory epilepsy - resective procedures

Palavras-chave

ilha de reil - córtex insular - epilepsia refratária - procedimentos ressectivos

O presente trabalho foi realizado na Faculdade de Medicina do ABC, Santo André, SP, Brazil.




Publication History

Received: 16 July 2021

Accepted: 06 April 2022

Article published online:
02 August 2022

© 2022. Sociedade Brasileira de Neurocirurgia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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