SEEG Implantation for Opercular Epilepsies

SUMMARY: Insulo-opercular epilepsies are rare, and pure opercular epilepsies are even rarer in the field of epilepsy surgery. They represent a complex form of focal epilepsy, often associated with noninformative MRI findings and, in some cases, extensive epileptogenic networks. In this context, stereoelectroencephalography (SEEG) is a critical tool for precise characterization of the epileptogenic zone (EZ) and for guiding surgical treatment; in selected cases, it may also serve as a therapeutic intervention through radiofrequency thermocoagulation (RFTC). The insulo-opercular region exhibits intricate intra- and extraregional structural and functional connectivity, requiring individualized implantation strategies. SEEG implantation combining orthogonal electrodes sampling different opercular areas with oblique electrodes targeting the insula enables comprehensive coverage of the epileptogenic network. Hypothesis-driven, patient-specific SEEG implantation-integrating detailed anatomical, functional, and semiological considerations-is essential for the evaluation and treatment of pure opercular and insulo-opercular epilepsies. Strategically tailored coverage not only enhances diagnostic accuracy but also enables targeted therapeutic interventions, ultimately improving surgical outcomes while minimizing postoperative risks.