An innovative surgical technique gives hope to patients suffering from refractory epilepsy.

Clinicians from the Centre hospitalier de l'Universite de Montreal (CHUM) have perfected an operation, which was previously considered too dangerous, to control refractory insular epilepsy, using an innovative microsurgery technique. According to a study published as the feature article in the latest issue of the Journal of Neurosurgery , the new surgical technique is both safe and beneficial for patients (see also Universite de Montreal Hospital Centre).

"Recent observations by our team and others confirm the previously unsuspected role played by the insula in cases of refractory epilepsy. The non-recognition of insular seizures has probably been responsible for some failures in epilepsy surgery in the past," note doctors Alain Bouthillier, neurosurgeon, and Dang Khoa Nguyen, neurologist, the study's principal investigators, who teach at Universite de Montreal and are researchers at the CHUM's research centre.

For many years, insular surgery to treat refractory epilepsy was abandoned and it is still rarely practiced because of the risk of damaging important structures of the brain. Initial attempts to resect the insula resulted in a high rate of complications, including hemiparesis (partial paralysis) and dysphasia (language loss). However, better understanding of the anatomy of the brain, in particular, the cerebral cortex and its vascular system, combined with the use of microsurgical techniques, now enable surgery to be performed on the insula, with greatly reduced risk to the patient. "This is the first cohort of patients with refractory epilepsy to have undergone such a procedure since the work of neurosurgeon Wilder Penfield in the 1950s," adds one of the investigators, Dr. Ramez Malak, neurosurgical resident.

Methodology

A retrospective study over the past ten years evaluated cases of patients with refractory epilepsy who had undergone insular surgery. In order to confirm the epileptic foci, intracranial electrodes were implanted, with the surgeon using neuronavigation and magnetic resonance imaging of the brain. Insulectomy was performed either as part of an insulooperculectomy, in which the insula and the opercula (meaning "lids": the lips of the deep fold that separates the ...