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The authors describe a strategy in which a small piece of gray matter is spared at the bottom of the periinsular sulcus, where the perforating arteries pass en route to the pyramidal tract, in order to avoid these complications. This method was successfully applied in 3 patients harboring focal cortical dysplasia in the posterior insula and frontoparietal operculum surrounding the periinsular sulcus. None of the patients developed permanent postoperative motor deficits, and seizure control was achieved in all 3 cases. The method described in this paper can be adopted for functional preservation of the pyramidal tract in the corona radiata when resecting epileptogenic pathologies involving insular and opercular regions.<\/jats:p>","DOI":"10.3171\/2017.1.jns161278","type":"journal-article","created":{"date-parts":[[2017,6,9]],"date-time":"2017-06-09T13:58:42Z","timestamp":1497016722000},"page":"1173-1177","source":"Crossref","is-referenced-by-count":24,"title":["Surgical strategy to avoid ischemic complications of the pyramidal tract in resective epilepsy surgery of the insula: technical case report"],"prefix":"10.3171","volume":"128","author":[{"given":"Naoki","family":"Ikegaya","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Epilepsy Center, National Center of Neurology and Psychiatry (NCNP), Kodaira;"},{"name":"Department of Neurosurgery, Yokohama City University, Yokohama; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akio","family":"Takahashi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Epilepsy Center, National Center of Neurology and Psychiatry (NCNP), Kodaira;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takanobu","family":"Kaido","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Epilepsy Center, National Center of Neurology and Psychiatry (NCNP), Kodaira;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuu","family":"Kaneko","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Epilepsy Center, National Center of Neurology and Psychiatry (NCNP), Kodaira;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masaki","family":"Iwasaki","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Epilepsy Center, National Center of Neurology and Psychiatry (NCNP), Kodaira;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nobutaka","family":"Kawahara","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Yokohama City University, Yokohama; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taisuke","family":"Otsuki","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Epilepsy Center, National Center of Neurology and Psychiatry (NCNP), Kodaira;"},{"name":"Epilepsy Hospital Bethel Japan, Iwanuma, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"Acta Neurochir (Wien)","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1007\/BF01418515","article-title":"Microsurgery of deep-seated cavernous angiomas: report of 26 cases","volume":"108","author":"Bertalanffy H","year":"1991","unstructured":"Bertalanffy H, Gilsbach JM, Eggert HR, Seeger W: Microsurgery of deep-seated cavernous angiomas: report of 26 cases. 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