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DEFINITION OF A STEREOTACTIC 3D MODEL OF THE HUMAN INSULA FOR NEUROSURGICAL APPROACH (EPILEPSY AND STEREOTAXIC SURGERY)
Neuroimaging studies have reported a large network of brain regions involved in altruism. However, these studies are unable to determine if these regions are necessary for altruistic attitudes. Here, we examined the brain-basis of everyday altruistic attitudes ([Self-Report Altruism Scale]; e.g., helping a stranger with car troubles) and potential factors (i.e., alexithymia [Toronto Alexithymia Scale] such as empathic concern [Interpersonal Reactivity Index]) that may moderate this relationship. We carried out whole-brain voxel-based lesion-symptom mapping and region of interest analyses to study a large sample of patients (n = 130) with penetrating traumatic brain injuries. Our results showed that the effect of anterior insula (AI) lesions was moderated by alexithymia, but not empathic concern. The presence of AI lesions, as well as increased alexithymia, were associated with fewer endorsements of resource-costly altruistic attitudes. Empathic concern was positively correlated with endorsements of resource-costly altruistic attitudes. Taken together, our study provides direct evidence that the AI and alexithymia play crucial roles in everyday altruistic attitudes and reinforces the importance of the emotional experience in altruism.
OBJECTIVE
Insular epilepsy is relatively rare; however, exploring the insular cortex when preoperative workup raises the suspicion of insular epilepsy is of paramount importance for accurate localization of the epileptogenic zone and achievement of seizure freedom. The authors review their clinical experience with stereoelectroencephalography (SEEG) electrode implantation in patients with medically intractable epilepsy and suspected insular involvement.
METHODS
A total of 198 consecutive cases in which patients underwent SEEG implantation with a total of 1556 electrodes between June 2009 and April 2013 were reviewed. The authors identified patients with suspected insular involvement based on seizure semiology, scalp EEG data, and preoperative imaging (MRI, PET, and SPECT or magnetoencephalography [MEG]). Patients with at least 1 insular electrode based on the postoperative 3D reconstruction of CT fused with the preoperative MRI were included.
RESULTS
One hundred thirty-five patients with suspected insular epilepsy underwent insular implantation of a total of 303 electrodes (1–6 insular electrodes per patient) with a total of 562 contacts. Two hundred sixty-eight electrodes (88.5%) were implanted orthogonally through the frontoparietal or temporal operculum (420 contacts). Thirty-five electrodes (11.5%) were implanted by means of an oblique trajectory either through a frontal or a parietal entry point (142 contacts). Nineteen patients (14.07%) had insular electrodes placed bilaterally. Twenty-three patients (17.04% of the insular implantation group and 11.6% of the whole SEEG cohort) were confirmed by SEEG to have ictal onset zones in the insula. None of the patients experienced any intracerebral hemorrhage related to the insular electrodes. After insular resection, 5 patients (33.3%) had Engel Class I outcomes, 6 patients (40%) had Engel Class II, 3 patients (20%) had Engel Class III, and 1 patient (6.66%) had Engel Class IV.
CONCLUSIONS
Insula exploration with stereotactically placed depth electrodes is a safe technique. Orthogonal electrodes are implanted when the hypothesis suggests opercular involvement; however, oblique electrodes allow a higher insular sampling rate.
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