Multiple subpial transections with concomitant responsive neurostimulation of the insula: illustrative case

• DOI: 10.3171/case24445
• Publication Date: 2025-04-01T03:47:11Z
• Authors: Robert Ziechmann; Kathleen Galligan; Marissa DiGiovine; Eric D. Marsh; Benjamin C. Kennedy
• Keywords: Neurostimulation; Hemispherectomy

BACKGROUND 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 performed to reduce burden of disabling seizures while avoiding disability associated resection brain. OBSERVATIONS A 17-year-old girl a history complex, refractory multifocal and previous right anterior temporal lobectomy left neocortical RNS presented status epilepticus. Scalp electroencephalography showed that began prior detection, suggesting focus outside lobe. MRI new edema throughout insula. MST concurrent insular lead placement were performed. The patient was discharged 2 weeks later, at 6-month follow-up, she had 100-fold reduction in clinical detections. LESSONS This technical report is first description 1) RNS, 2) paddle electrode for over surface insula using transsylvian approach. Surgery this case provided both immediate sustained several months. https://thejns.org/doi/10.3171/CASE24445