{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T11:03:52Z","timestamp":1770116632051,"version":"3.49.0"},"reference-count":22,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"13","license":[{"start":{"date-parts":[[2025,3,31]],"date-time":"2025-03-31T00:00:00Z","timestamp":1743379200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Cosmet Laser Ther"],"published-print":{"date-parts":[[2025,3,31]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Focal epilepsy arising from the eloquent cortex can be treated with palliative surgical interventions such as multiple subpial transection (MST) or responsive neurostimulation (RNS). These techniques can be performed to reduce the burden of disabling seizures while avoiding disability associated with resection of the eloquent brain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>A 17-year-old girl with a history of complex, refractory multifocal epilepsy and previous right anterior temporal lobectomy and left temporal neocortical RNS presented with refractory status epilepticus. Scalp electroencephalography showed seizures that began prior to RNS detection, suggesting a focus outside of the left anterior temporal lobe. MRI showed new edema throughout the left insula. MST and concurrent insular RNS lead placement were performed. The patient was discharged 2 weeks later, and at the 6-month follow-up, she had a 100-fold reduction in clinical seizures and RNS detections.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>This technical report is the first description of 1) concurrent MST and RNS, and 2) placement of a paddle electrode for the RNS over the surface of the insula using a transsylvian approach.<\/jats:p>\n                    <jats:p>Surgery in this case provided both immediate and sustained reduction in disabling seizures over several months.<\/jats:p>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/thejns.org\/doi\/10.3171\/CASE24445\">https:\/\/thejns.org\/doi\/10.3171\/CASE24445<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case24445","type":"journal-article","created":{"date-parts":[[2025,3,31]],"date-time":"2025-03-31T23:47:11Z","timestamp":1743464831000},"source":"Crossref","is-referenced-by-count":0,"title":["Multiple subpial transections with concomitant responsive neurostimulation of the insula: illustrative case"],"prefix":"10.3171","volume":"9","author":[{"given":"Robert","family":"Ziechmann","sequence":"first","affiliation":[{"name":"Division of Neurosurgery, Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania"},{"name":"Department of Neurosurgery, Temple University Hospital, Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kathleen","family":"Galligan","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marissa","family":"DiGiovine","sequence":"additional","affiliation":[{"name":"Division of Child Neurology, Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eric D.","family":"Marsh","sequence":"additional","affiliation":[{"name":"Division of Child Neurology, Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania"},{"name":"Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4446-5243","authenticated-orcid":true,"given":"Benjamin C.","family":"Kennedy","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania"},{"name":"Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"1","key":"bib1","series-title":"Epilepsy Behav","first-page":"68","article-title":"A modern epilepsy surgery treatment algorithm: incorporating traditional and emerging technologies","volume":"80","author":"Englot","year":"2018","unstructured":"Englot DJ.A modern epilepsy surgery treatment algorithm: incorporating traditional and emerging technologies. Epilepsy Behav. 2018;80(1):68-74."},{"issue":"1","key":"bib2","series-title":"J Neurosurg","first-page":"39","article-title":"Multiple subpial transections: outcome and complications in 20 patients who did not undergo resection","volume":"97","author":"Schramm","year":"2002","unstructured":"Schramm JAliashkevich AFGrunwald T.Multiple subpial transections: outcome and complications in 20 patients who did not undergo resection. J Neurosurg. 2002;97(1):39-47."},{"issue":"9","key":"bib3","series-title":"Neurology","article-title":"Nine-year prospective efficacy and safety of brain-responsive neurostimulation for focal epilepsy","volume":"95","author":"Nair","year":"2020","unstructured":"Nair DRLaxer KDWeber PBNine-year prospective efficacy and safety of brain-responsive neurostimulation for focal epilepsy. Neurology. 2020;95(9):e1244-e1256."},{"issue":"1","key":"bib4","series-title":"Epilepsia","first-page":"68","article-title":"Surgical treatment of status epilepticus: a palliative approach","volume":"54","author":"Winkler","year":"2013","unstructured":"Winkler PA.Surgical treatment of status epilepticus: a palliative approach. Epilepsia. 2013;54(1suppl 6):68-71."},{"issue":"2","key":"bib5","series-title":"Epilepsia","first-page":"141","article-title":"Multiple subpial transection for intractable partial epilepsy: an international meta-analysis","volume":"43","author":"Spencer","year":"2002","unstructured":"Spencer SSSchramm JWyler AMultiple subpial transection for intractable partial epilepsy: an international meta-analysis. Epilepsia. 2002;43(2):141-145."},{"issue":"5","key":"bib6","series-title":"W V Med J","first-page":"20","article-title":"Neurosurgical therapy for central area status epilepticus","volume":"108","author":"Weimer","year":"2012","unstructured":"Weimer TBoling WPalade A.Neurosurgical therapy for central area status epilepticus. W V Med J. 2012;108(5):20-23."},{"issue":"1","key":"bib7","series-title":"J Neurosurg","first-page":"201","article-title":"Responsive neurostimulation as a treatment for super-refractory focal status epilepticus: a systematic review and case series","volume":"140","author":"Ernst","year":"2024","unstructured":"Ernst LDRaslan AMWabulya AResponsive neurostimulation as a treatment for super-refractory focal status epilepticus: a systematic review and case series. J Neurosurg. 2024;140(1):201-209."},{"issue":"1","key":"bib8","series-title":"Epilepsia Open","first-page":"12","article-title":"Predictors of outcomes after surgery for medically intractable insular epilepsy: a systematic review and individual participant data meta-analysis","volume":"8","author":"Obaid","year":"2023","unstructured":"Obaid SChen JSIbrahim GMPredictors of outcomes after surgery for medically intractable insular epilepsy: a systematic review and individual participant data meta-analysis. Epilepsia Open. 2023;8(1):12-31."},{"issue":"2","key":"bib9","series-title":"J Neurosurg","first-page":"523","article-title":"Insular epilepsy surgery: lessons learned from institutional review and patient-level meta-analysis","volume":"136","author":"Kerezoudis","year":"2022","unstructured":"Kerezoudis PSingh RGoyal AInsular epilepsy surgery: lessons learned from institutional review and patient-level meta-analysis. J Neurosurg. 2022;136(2):523-535."},{"issue":"1","key":"bib10","series-title":"Epilepsy Curr","first-page":"11","article-title":"The insula and its epilepsies","volume":"19","author":"Jobst","year":"2019","unstructured":"Jobst BCGonzalez-Martinez JIsnard JThe insula and its epilepsies. Epilepsy Curr. 2019;19(1):11-21."},{"issue":"4","key":"bib11","series-title":"Neurosurgery","first-page":"E730","article-title":"Open resection versus laser interstitial thermal therapy for the treatment of pediatric insular epilepsy","volume":"85","author":"Hale","year":"2019","unstructured":"Hale ATSen SHaider ASOpen resection versus laser interstitial thermal therapy for the treatment of pediatric insular epilepsy. 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W V Med J. 2012;108(5):20-23."},{"issue":"1","key":"bib7","series-title":"J Neurosurg","first-page":"201","article-title":"Responsive neurostimulation as a treatment for super-refractory focal status epilepticus: a systematic review and case series","volume":"140","author":"Ernst","year":"2024","unstructured":"Ernst LDRaslan AMWabulya AResponsive neurostimulation as a treatment for super-refractory focal status epilepticus: a systematic review and case series. J Neurosurg. 2024;140(1):201-209."},{"issue":"1","key":"bib8","series-title":"Epilepsia Open","first-page":"12","article-title":"Predictors of outcomes after surgery for medically intractable insular epilepsy: a systematic review and individual participant data meta-analysis","volume":"8","author":"Obaid","year":"2023","unstructured":"Obaid SChen JSIbrahim GMPredictors of outcomes after surgery for medically intractable insular epilepsy: a systematic review and individual participant data meta-analysis. Epilepsia Open. 2023;8(1):12-31."},{"issue":"2","key":"bib9","series-title":"J Neurosurg","first-page":"523","article-title":"Insular epilepsy surgery: lessons learned from institutional review and patient-level meta-analysis","volume":"136","author":"Kerezoudis","year":"2022","unstructured":"Kerezoudis PSingh RGoyal AInsular epilepsy surgery: lessons learned from institutional review and patient-level meta-analysis. J Neurosurg. 2022;136(2):523-535."},{"issue":"1","key":"bib10","series-title":"Epilepsy Curr","first-page":"11","article-title":"The insula and its epilepsies","volume":"19","author":"Jobst","year":"2019","unstructured":"Jobst BCGonzalez-Martinez JIsnard JThe insula and its epilepsies. Epilepsy Curr. 2019;19(1):11-21."},{"issue":"4","key":"bib11","series-title":"Neurosurgery","first-page":"E730","article-title":"Open resection versus laser interstitial thermal therapy for the treatment of pediatric insular epilepsy","volume":"85","author":"Hale","year":"2019","unstructured":"Hale ATSen SHaider ASOpen resection versus laser interstitial thermal therapy for the treatment of pediatric insular epilepsy. 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