Anatomical Categorization of Insulo-opercular Focal Cortical Dysplasia and the Spatial Patterns of Stereo-electroencephalography
Abstract number :
1.338
Submission category :
4. Clinical Epilepsy / 4C. Clinical Treatments
Year :
2024
Submission ID :
700
Source :
www.aesnet.org
Presentation date :
12/7/2024 12:00:00 AM
Published date :
Authors :
Presenting Author: Wenhan Hu, MD – Beijing Tiantan Hospital
Bowen Yang, MD, PhD – Beijing Tiantan Hospital
Kai Zhang, MD – Beijing Tiantan Hospital
Chao Zhang, MD – Beijing Tiantan Hospital
Xiu Wang, MD, PhD – Beijing Tiantan Hospital
Baotian Zhao, MD – Beijing Tiantan Hospital
Jiajie Mo, MD, PhD – Beijing Tiantan Hospital
Rationale: To anatomically categorize insulo-opercular focal cortical dysplasia (FCD) lesions according to their location and extent, and to summarize the corresponding stereo-electroencephalographic (SEEG) patterns to guide preoperative evaluation and surgical planning.
Methods: Patients who underwent epilepsy surgery for insulo-opercular FCD at the Beijing Tiantan-Fengtai Epilepsy Center from 2015 to 2022 were included in the study. FCD lesions were classified into insular, peri-insular, opercular, and complex types based on their location and extent, derived from electro-clinical and neuroimaging data. SEEG signals from the seizure-onset electrodes were collected for quantitative analysis; the normalized interictal high-frequency oscillation (HFO) count and ictal epileptogenicity index (EI) value of insular and opercular channels were calculated. Spatial patterns of HFO count and EI value among insular, peri-insular, and opercular types were analyzed. Cluster analyses utilizing HFO count and EI value were performed to automatically categorize insular, peri-insular, and opercular FCDs, and the results were compared with manual categorization from preoperative evaluations.
Results: A total of 53 patients with insulo-opercular FCD were included, comprising 10 insular, 17 peri-insular, 24 opercular, and 2 complex cases. Thirty-eight patients were included in the quantitative SEEG analysis. The HFO and EI analyses indicated that, in insular FCDs, the values of the two parameters were higher in insular channels than in opercular channels (p=0.090 for HFO and p< 0.001 for EI); in peri-insular FCDs, the values in insular and opercular channels were comparable (p=0.81 for HFO and p=0.51 for EI); and in opercular FCDs, the values were higher in opercular channels than in insular channels (p< 0.001 for HFO and EI). The accuracy of the cluster analysis based on HFO count and EI value was 76.3% (29/38) and 86.8% (33/38), respectively. Surgical strategies were proposed according to the anatomical categorization, achieving a favorable postoperative seizure-free rate of 84.91%.
Clinical Epilepsy