Periinsular anterior quadrantotomy: technical note.

Details

Serval ID
serval:BIB_6B81BF7F05D7
Type
Article: article from journal or magazin.
Publication sub-type
Review (review): journal as complete as possible of one specific subject, written based on exhaustive analyses from published work.
Collection
Publications
Institution
Title
Periinsular anterior quadrantotomy: technical note.
Journal
Journal of neurosurgery. Pediatrics
Author(s)
Cossu G., Lebon S., Seeck M., Pralong E., Messerer M., Roulet-Perez E., Daniel R.T.
ISSN
1933-0715 (Electronic)
ISSN-L
1933-0707
Publication state
Published
Issued date
02/2018
Peer-reviewed
Oui
Volume
21
Number
2
Pages
124-132
Language
english
Notes
Publication types: Case Reports ; Journal Article
Publication Status: ppublish
Abstract
Refractory frontal lobe epilepsy has been traditionally treated through a frontal lobectomy. A disconnective technique may allow similar seizure outcomes while avoiding the complications associated with large brain resections. The aim of this study was to describe a new technique of selective disconnection of the frontal lobe that can be performed in cases of refractory epilepsy due to epileptogenic foci involving 1 frontal lobe (anterior to the motor cortex), with preservation of motor function. In addition to the description of the technique, an illustrative case is also presented. This disconnective procedure is divided into 4 steps: the suprainsular window, the anterior callosotomy, the intrafrontal disconnection, and the frontobasal disconnection. The functional neuroanatomy is analyzed in detail for each step of the surgery. It is important to perform cortical and subcortical electrophysiological mapping to guide this disconnective procedure and identify eloquent cortices and intact neural pathways. The authors describe the case of a 9-year-old boy who presented with refractory epilepsy due to epileptogenic foci localized to the right frontal lobe. MRI confirmed the presence of a focal cortical dysplasia of the right frontal lobe. A periinsular anterior quadrant disconnection (quadrantotomy) was performed. The postoperative period was uneventful, and the patient was in Engel seizure outcome Class I at the 3-year follow-up. A significant cognitive gain was observed during follow-up. Periinsular anterior quadrantotomy may thus represent a safe technique to efficiently treat refractory epilepsy when epileptogenic foci are localized to 1 frontal lobe while preserving residual motor functions.
Keywords
Child, Electroencephalography, Epilepsy/surgery, Frontal Lobe/surgery, Humans, Magnetic Resonance Imaging, Male, Neurosurgical Procedures/methods, Prefrontal Cortex/surgery, EEG = electroencephalography, IFG = inferior frontal gyrus, IFOF = inferior frontoocipital fasciculus, MFG = middle frontal gyrus, SFG = superior frontal gyrus, anterior hemi-hemispherotomy, anterior quadrantotomy, disconnection technique, epilepsy surgery, hemimegalencephaly, refractory epilepsy, surgical technique
Pubmed
Web of science
Open Access
Yes
Create date
14/12/2017 18:01
Last modification date
26/03/2020 18:57
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