Cognitive and developmental outcomes after pediatric insular epilepsy surgery for focal cortical dysplasia

被引:19
作者
Ikegaya, Naoki [1 ,3 ]
Iwasaki, Masaki [1 ]
Kaneko, Yuu [1 ]
Kaido, Takanobu [1 ,4 ]
Kimura, Yuiko [1 ]
Yamamoto, Tetsuya [3 ]
Sumitomo, Noriko [2 ]
Saito, Takashi [2 ]
Nakagawa, Eiji [2 ]
Sugai, Kenji [2 ]
Sasaki, Masayuki [2 ]
Takahashi, Akio [1 ,5 ]
Otsuki, Taisuke [1 ,6 ]
机构
[1] Natl Ctr Hosp, Natl Ctr Neurol & Psychiat NCNP, Dept Neurosurg, Epilepsy Ctr, Tokyo, Japan
[2] Natl Ctr Hosp, Natl Ctr Neurol & Psychiat NCNP, Dept Child Neurol, Epilepsy Ctr, Tokyo, Japan
[3] Yokohama City Univ, Epilepsy Ctr, Dept Neurosurg, Sch Med, Yokohama, Kanagawa, Japan
[4] Osaka Shoin Womens Univ, Fac Hlth & Nutr, Dept Hlth & Nutr, Higashiosaka, Osaka, Japan
[5] Shibukawa Med Ctr, Dept Neurosurg, Gunma, Japan
[6] Epilepsy Hosp Bethel Japan, Iwanuma, Miyagi, Japan
关键词
epilepsy surgery; insula; focal cortical dysplasia; cognitive; developmental; ORGANIZATION; CORTEX;
D O I
10.3171/2020.5.PEDS2058
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
OBJECTIVE Cognitive risk associated with insular cortex resection is not well understood. The authors reviewed cognitive and developmental outcomes in pediatric patients who underwent resection of the epileptogenic zone involving the insula. METHODS A review was conducted of 15 patients who underwent resective epilepsy surgery involving the insular cortex for focal cortical dysplasia, with a minimum follow-up of 12 months. The median age at surgery was 5.6 years (range 0.3-13.6 years). Developmental/intelligence quotient (DQ/IQ) scores were evaluated before surgery, within 4 months after surgery, and at 12 months or more after surgery. Repeated measures multivariate ANOVA was used to evaluate the effects on outcomes of the within-subject factor (time) and between-subject factors (resection side, anterior insular resection, seizure control, and antiepileptic drug [AED] reduction). RESULTS The mean preoperative DQ/IQ score was 60.7 +/- 22.8. Left-side resection and anterior insular resection were performed in 9 patients each. Favorable seizure control (International League Against Epilepsy class 1-3) was achieved in 8 patients. Postoperative motor deficits were observed in 9 patients (permanent in 6, transient in 3). Within-subject changes in DQ/IQ were not significantly affected by insular resection (p = 0.13). Postoperative changes in DQ/IQ were not significantly affected by surgical side, anterior insular resection, AED reduction, or seizure outcome. Only verbal function showed no significant changes before and after surgery and no significant effects of within-subject factors. CONCLUSIONS Resection involving the insula in children with impaired development or intelligence can be performed without significant reduction in DQ/IQ, but carries the risk of postoperative motor deficits.
引用
收藏
页码:543 / 551
页数:9
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