Surgical strategies and seizure outcomes of patients with epilepsy due to insular lesions

Objective To explore the clinical manifestation,seizure semiology,surgical strategies and outcomes of patients with epilepsy due to insular lesions.Methods The clinical data of 18 patients who underwent resection of insular lesion between October 2008 and October 2010 were collected.The semiology, MRI and EEG findings, surgical strategies and postoperative follow - up outcomes were evaluated.Results Among 18 patients,11patients were female.The seizure was the initial symptom in 14 patients.The lesions of 4 patients(22％) were in the left hemisphere and 14(78％) in the right.The lesions of 9 patients were within insular,the other 9 extended either to the frontal ( n =4) or temporal lobes ( n =3) or both ( n =2).Through transsylvian surgical approach,combined with frontal opercular resection or temporal lobectomy when necessary,11patients (61％) underwent complete resection of the lesions,6 patients (39％) underwent subtotal resection.14 patients suffered from glial/glioneural tumors,4 from cavernomas.The mean follow - up duration was 20.8 months ( ranged from 11to 33 months ).13 patients (72％) were completely seizure free.Conclusions Resection of insular lesion is acceptably safe and could provide a high rate of satisfactory seizure relief. Key words: Insular lobe; Epilepsy; Surgery; Seizure outcome