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In eight patients where FCD was the most likely etiology, the histology was negative. Seven patients (23%) displayed normal magnetic resonance imaging results. Seizures exhibited diverse semiology and propagation patterns (frontal, perisylvian, and temporal). The ictal and interictal electroencephalographic (EEG) findings were mostly extensive. Multimodal imaging and advanced postprocessing were frequently used. Stereo\u2010EEG was used for localizing the epileptogenic zone and eloquent cortex in 23 patients (77%). Oblique electrodes were used as guides for better neurosurgeon orientation. The epileptogenic zone was in the dominant hemisphere in 16 patients. At the 2\u2010year follow\u2010up, 22 patients (73%) were completely seizure\u2010free, and eight (27%) experienced a seizure frequency reduction of &gt;50% (International League Against Epilepsy class 3 and 4). Fourteen patients (47%) underwent antiseizure medication tapering; treatment was completely withdrawn in two (7%). Nineteen patients (63%) remained seizure\u2010free following the definitive outcome assessment (median\u2009=\u20096\u2009years 5\u2009months, range\u2009=\u20092\u2009years to 13\u2009years 5\u2009months postsurgery). Six patients (20%) experienced corona radiata or basal ganglia ischemia; four (13%) improved to mild and one (3%) to moderate hemiparesis. Two patients (7%) operated on in the anterior insula along with frontotemporal resection experienced major complications: pontine ischemia and postoperative brain edema.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Significance<\/jats:title>\n                    <jats:p>Epilepsy surgery in the operculoinsular cortex can lead to excellent patient outcomes. A comprehensive diagnostic approach is crucial for surgical success. Rehabilitation brings a great chance for significant recovery of postoperative deficits.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/epi.18185","type":"journal-article","created":{"date-parts":[[2024,12,5]],"date-time":"2024-12-05T09:25:38Z","timestamp":1733390738000},"page":"444-457","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Epilepsy surgery in children with operculoinsular epilepsy: Results of a large unicentric cohort"],"prefix":"10.1111","volume":"66","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7853-3446","authenticated-orcid":false,"given":"Martin","family":"Kudr","sequence":"first","affiliation":[{"name":"Department of Paediatric Neurology, Second Faculty of Medicine Charles University and Motol University Hospital  Prague Czech Republic"},{"name":"European Reference Network EpiCARE  Prague Czech Republic"},{"name":"Epilepsy Research Centre Prague\u2013EpiReC Consortium  Prague Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0825-1069","authenticated-orcid":false,"given":"Radek","family":"Janca","sequence":"additional","affiliation":[{"name":"Epilepsy Research Centre Prague\u2013EpiReC Consortium  Prague Czech Republic"},{"name":"Department of Circuit Theory, Faculty of Electrical Engineering Czech Technical University  Prague Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alena","family":"Jahodova","sequence":"additional","affiliation":[{"name":"Department of Paediatric Neurology, Second Faculty of Medicine Charles University and Motol University Hospital  Prague Czech Republic"},{"name":"European Reference Network EpiCARE  Prague Czech Republic"},{"name":"Epilepsy Research Centre Prague\u2013EpiReC Consortium  Prague Czech 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