{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T22:00:26Z","timestamp":1782511226230,"version":"3.54.5"},"reference-count":37,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["PED"],"published-print":{"date-parts":[[2016,11]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>Insular lobe epilepsy (ILE) is an under-recognized cause of extratemporal epilepsy and explains some epilepsy surgery failures in children with drug-resistant epilepsy. The diagnosis of ILE usually requires invasive investigation with insular sampling; however, the location of the insula below the opercula and the dense middle cerebral artery vasculature renders its sampling challenging. Several techniques have been described, ranging from open direct placement of orthogonal subpial depth and strip electrodes through a craniotomy to frame-based stereotactic placement of orthogonal or oblique electrodes using stereo-electroencephalography principles. The authors describe an alternative method for sampling the insula, which involves placing insular depth electrodes along the long axis of the insula through the insular apex following dissection of the sylvian fissure in conjunction with subdural electrodes over the lateral hemispheric\/opercular region. The authors report the feasibility, advantages, disadvantages, and role of this approach in investigating pediatric insular-opercular refractory epilepsy.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>The authors performed a retrospective analysis of all children (&lt; 18 years old) who underwent invasive intracranial studies involving the insula between 2002 and 2015.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>Eleven patients were included in the study (5 boys). The mean age at surgery was 7.6 years (range 0.5\u201316 years). All patients had drug-resistant epilepsy as defined by the International League Against Epilepsy and underwent comprehensive noninvasive epilepsy surgery workup. Intracranial monitoring was performed in all patients using 1 parasagittal insular electrode (1 patient had 2 electrodes) in addition to subdural grids and strips tailored to the suspected epileptogenic zone. In 10 patients, extraoperative monitoring was used; in 1 patient, intraoperative electrocorticography was used alone without extraoperative monitoring. The mean number of insular contacts was 6.8 (range 4\u20138), and the mean number of fronto-parieto-temporal hemispheric contacts was 61.7 (range 40\u201392). There were no complications related to placement of these depth electrodes. All 11 patients underwent subsequent resective surgery involving the insula.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>Parasagittal transinsular apex depth electrode placement is a feasible alternative to orthogonally placed open or oblique-placed stereotactic methodologies. This method is safe and best suited for suspected unilateral cases with a possible extensive insular-opercular epileptogenic zone.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2016.4.peds15636","type":"journal-article","created":{"date-parts":[[2016,7,29]],"date-time":"2016-07-29T13:58:14Z","timestamp":1469800694000},"page":"511-522","source":"Crossref","is-referenced-by-count":26,"title":["Medically resistant pediatric insular-opercular\/perisylvian epilepsy. Part 1: invasive monitoring using the parasagittal transinsular apex depth electrode"],"prefix":"10.3171","volume":"18","author":[{"given":"Alexander G.","family":"Weil","sequence":"first","affiliation":[{"name":"Divisions of Pediatric Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aria","family":"Fallah","sequence":"additional","affiliation":[{"name":"Divisions of Pediatric Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evan C.","family":"Lewis","sequence":"additional","affiliation":[{"name":"Pediatric Neurology, Miami (Nicklaus) Children's Hospital, Miami, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanjiv","family":"Bhatia","sequence":"additional","affiliation":[{"name":"Divisions of Pediatric Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"5 Suppl 2","key":"b1-peds15636","series-title":"Neurosurgery","first-page":"ONS471","article-title":"Safety and usefulness of insular depth electrodes implanted via an oblique approach in patients with epilepsy.","volume":"62","author":"Afif","year":"2008"},{"key":"b2-peds15636","series-title":"Epilepsia","doi-asserted-by":"publisher","first-page":"230","DOI":"10.1111\/j.0013-9580.2004.43003.x","article-title":"Patients with temporoparietal ictal symptoms and inferomesial EEG do not benefit from anterior temporal resection","volume":"45","author":"Aghakhani","year":"2004"},{"key":"b3-peds15636","series-title":"Rev Otoneuroophtalmol","first-page":"315","article-title":"[Methodology of stereo EEG exploration and surgical intervention in epilepsy.]","volume":"45","author":"Bancaud","year":"1973"},{"key":"b4-peds15636","series-title":"Brain","doi-asserted-by":"publisher","first-page":"1957","DOI":"10.1093\/brain\/awm108","article-title":"Ictal clinical and scalp-EEG findings differentiating temporal lobe epilepsies from temporal \u2018plus\u2019 epilepsies","volume":"130","author":"Barba","year":"2007"},{"key":"b5-peds15636","series-title":"Epilepsia","doi-asserted-by":"publisher","first-page":"1658","DOI":"10.1111\/epi.12260","article-title":"Prognostic value of insular lobe involvement in temporal lobe epilepsy: a stereoelectroencephalo-graphic study","volume":"54","author":"Blauwblomme","year":"2013"},{"key":"b6-peds15636","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"706","DOI":"10.1227\/01.NEU.0000176656.33523.1e","article-title":"Stereoelectroencephalography in the presurgical evaluation of focal epilepsy: a retrospective analysis of 215 procedures","volume":"57","author":"Cossu","year":"2005"},{"key":"b7-peds15636","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"483","DOI":"10.3171\/jns.2006.104.4.483","article-title":"Efficacy of and morbidity associated with stereoelectroencephalography using computerized tomography\u2014or magnetic resonance imaging-guided electrode implantation","volume":"104","author":"De Almeida","year":"2006"},{"issue":"3","key":"b8-peds15636","series-title":"Neurosurg Focus","doi-asserted-by":"publisher","first-page":"E6","DOI":"10.3171\/2012.1.FOCUS11325","article-title":"Surgical techniques for investigating the role of the insula in epilepsy: a review","volume":"32","author":"Desai","year":"2012"},{"key":"b9-peds15636","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"1176","DOI":"10.3171\/2010.9.JNS091803","article-title":"Stereotactic depth electrode investigation of the insula in the evaluation of medically intractable epilepsy","volume":"114","author":"Desai","year":"2011"},{"key":"b10-peds15636","series-title":"Epilepsia","doi-asserted-by":"publisher","first-page":"159","DOI":"10.1111\/j.1528-1167.2007.01426.x","article-title":"Successful surgical treatment of insular epilepsy with nocturnal hypermotor seizures","volume":"49","author":"Dobesberger","year":"2008"},{"key":"b11-peds15636","series-title":"Handb Clin Neurol","doi-asserted-by":"publisher","first-page":"829","DOI":"10.1016\/B978-0-444-52899-5.00031-9","article-title":"Preoperative evaluation in children for epilepsy surgery","volume":"108","author":"Duchowny","year":"2012"},{"key":"b12-peds15636","series-title":"Acta Neurochir (Wien)","doi-asserted-by":"publisher","first-page":"563","DOI":"10.1007\/s00701-002-0941-6","article-title":"Medically intractable epilepsy from insular low-grade gliomas: improvement after an extended lesionectomy","volume":"144","author":"Duffau","year":"2002"},{"key":"b13-peds15636","series-title":"Seizure","doi-asserted-by":"publisher","first-page":"300","DOI":"10.1016\/j.seizure.2014.01.008","article-title":"Insular and insulo-opercular epilepsy in childhood: an SEEG study","volume":"23","author":"Dylgjeri","year":"2014"},{"key":"b14-peds15636","series-title":"Neurochirurgie","doi-asserted-by":"publisher","first-page":"374","DOI":"10.1016\/j.neuchi.2008.02.010","article-title":"[Epilepsy and insula.]","volume":"54","author":"Guenot","year":"2008"},{"key":"b15-peds15636","series-title":"Ann Neurol","doi-asserted-by":"publisher","first-page":"614","DOI":"10.1002\/1531-8249(200010)48:4<614::AID-ANA8>3.0.CO;2-S","article-title":"The role of the insular cortex in temporal lobe epilepsy","volume":"48","author":"Isnard","year":"2000"},{"key":"b16-peds15636","series-title":"Epilepsia","doi-asserted-by":"publisher","first-page":"1079","DOI":"10.1111\/j.0013-9580.2004.68903.x","article-title":"Clinical manifestations of insular lobe seizures: a stereo-electroencephalographic study","volume":"45","author":"Isnard","year":"2004"},{"key":"b17-peds15636","series-title":"Rev Neurol (Paris)","first-page":"17","article-title":"[The insula in partial epilepsy.]","volume":"161","author":"Isnard","year":"2005"},{"key":"b18-peds15636","series-title":"Epilepsia","doi-asserted-by":"publisher","first-page":"507","DOI":"10.1111\/epi.12544","article-title":"Diagnostic test utilization in evaluation for resective epilepsy surgery in children","volume":"55","author":"Jayakar","year":"2014"},{"key":"b19-peds15636","series-title":"J Neurosurg Pediatr","doi-asserted-by":"publisher","first-page":"365","DOI":"10.3171\/2009.11.PEDS09169","article-title":"Insular epilepsy masquerading as multifocal cortical epilepsy as proven by depth electrode","volume":"5","author":"Levitt","year":"2010"},{"key":"b20-peds15636","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"1153","DOI":"10.3171\/2009.1.JNS08807","article-title":"Microsurgery of epileptic foci in the insular region","volume":"110","author":"Malak","year":"2009"},{"key":"b21-peds15636","series-title":"Epilepsia","doi-asserted-by":"publisher","first-page":"1950","DOI":"10.1111\/epi.12376","article-title":"The utility of magnetoencephalography in the presurgical evaluation of refractory insular epilepsy","volume":"54","author":"Mohamed","year":"2013"},{"issue":"Suppl 2","key":"b22-peds15636","series-title":"Can J Neurol Sci","first-page":"S58","article-title":"Insular cortex epilepsy: an overview","volume":"36","author":"Nguyen","year":"2009"},{"key":"b23-peds15636","series-title":"Epilepsia","doi-asserted-by":"publisher","first-page":"510","DOI":"10.1111\/j.1528-1167.2008.01758.x","article-title":"Revisiting the role of the insula in refractory partial epilepsy","volume":"50","author":"Nguyen","year":"2009"},{"key":"b24-peds15636","series-title":"Childs Nerv Syst","doi-asserted-by":"publisher","first-page":"591","DOI":"10.1007\/s00381-008-0764-8","article-title":"Insular epilepsy surgery under neuronavigation guidance using depth electrode","volume":"25","author":"Park","year":"2009"},{"key":"b25-peds15636","series-title":"Brain","first-page":"445","article-title":"The insula; further observations on its function","volume":"78","author":"Penfield","year":"1955"},{"key":"b26-peds15636","series-title":"Epilepsia","doi-asserted-by":"publisher","first-page":"1781","DOI":"10.1111\/j.1528-1167.2011.03254.x","article-title":"Insular-opercular seizures manifesting with sleep-related paroxysmal motor behaviors: a stereo-EEG study","volume":"52","author":"Proserpio","year":"2011"},{"key":"b27-peds15636","series-title":"Stereotact Funct Neurosurg","doi-asserted-by":"publisher","first-page":"368","DOI":"10.1159\/000249818","article-title":"Parasagittal transinsular electrodes for stereo-EEG in temporal and insular lobe epilepsies","volume":"87","author":"Robles","year":"2009"},{"key":"b28-peds15636","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"266","DOI":"10.3171\/jns.1993.79.2.0266","article-title":"Surgical treatment of partial epilepsy arising from the insular cortex. Report of two cases","volume":"79","author":"Roper","year":"1993"},{"key":"b29-peds15636","series-title":"Curr Opin Neurol","doi-asserted-by":"publisher","first-page":"125","DOI":"10.1097\/01.wco.0000162852.22026.6f","article-title":"The hidden causes of surgery-resistant temporal lobe epilepsy: extratemporal or temporal plus?","volume":"18","author":"Ryvlin","year":"2005"},{"key":"b30-peds15636","series-title":"Epilepsia","doi-asserted-by":"publisher","first-page":"755","DOI":"10.1111\/j.1528-1167.2006.00510.x","article-title":"Nocturnal hypermotor seizures, suggesting frontal lobe epilepsy, can originate in the insula","volume":"47","author":"Ryvlin","year":"2006"},{"key":"b31-peds15636","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"356","DOI":"10.1097\/00007632-199103000-00017","article-title":"Diptheroids and associated infections as a cause of failed instrument stabilization procedures in the lumbar spine","volume":"16","author":"Schofferman","year":"1991"},{"key":"b32-peds15636","series-title":"Epilepsia","doi-asserted-by":"publisher","first-page":"307","DOI":"10.1111\/j.1528-1157.1964.tb03338.x","article-title":"Evaluation of insular ablation in surgical treatment of temporal lobe epilepsy","volume":"5","author":"Silfvenius","year":"1964"},{"key":"b33-peds15636","series-title":"Epilepsia","doi-asserted-by":"publisher","first-page":"458","DOI":"10.1111\/j.1528-1167.2010.02910.x","article-title":"The combination of subdural and depth electrodes for intracranial EEG investigation of suspected insular (perisylvian) epilepsy","volume":"52","author":"Surbeck","year":"2011"},{"key":"b34-peds15636","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"891","DOI":"10.3171\/jns.2004.100.5.0891","article-title":"Microsurgical anatomy of the insula and the sylvian fissure","volume":"100","author":"Tanriover","year":"2004"},{"key":"b35-peds15636","series-title":"Seizure","doi-asserted-by":"publisher","first-page":"631","DOI":"10.1016\/j.seizure.2012.07.004","article-title":"Invasive explorations in children younger than 3 years","volume":"21","author":"Taussig","year":"2012"},{"key":"b36-peds15636","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"720","DOI":"10.3171\/jns.1999.90.4.0720","article-title":"Topographic anatomy of the insular region","volume":"90","author":"T\u00fcre","year":"1999"},{"key":"b37-peds15636","series-title":"Brain","first-page":"1048","article-title":"Insular lesionectomy for refractory epilepsy: management and outcome","volume":"132","author":"von Lehe","year":"2009"}],"container-title":["Journal of Neurosurgery: Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/18\/5\/article-p511.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/18\/5\/article-p511.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/18\/5\/article-p511.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,15]],"date-time":"2023-04-15T13:10:16Z","timestamp":1681564216000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/18\/5\/article-p511.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,11]]},"references-count":37,"journal-issue":{"issue":"5"},"URL":"https:\/\/doi.org\/10.3171\/2016.4.peds15636","relation":{},"ISSN":["1933-0707","1933-0715"],"issn-type":[{"value":"1933-0707","type":"print"},{"value":"1933-0715","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,11]]}}}