Issue release date: 12.11.2024
2Ministry of Health Ankara Training and Research Hospital, Department of Neurology
3Gazi University School of Medicine, Department of Pediatric Neurology Extratemporal epilepsies are difficult to detect and to localize electrographically. The surgical success rate in extratemporal lobe epilepsy (ExTLE) has been low but might be increased by using invasive electrodes and functional mapping. We describe the preoperative evaluation and surgical approach for an ExTLE patient.
A 31-year-old man underwent intracerebral left frontal lobe abscess drainage and capsula excision four years ago. He was re-admitted with a seizure nine months after the surgery. His typical seizure was a secondary generalized tonic clonic seizure that was resistant to antiepileptic drugs. Video/EEG monitorization was performed, first with scalp electrodes and then with the subdural grid electrode. The Ojemann Cortical Stimulator was used for functional brain mapping. Language function and the epileptogenic focus area were determined. Cortical resection of the epileptogenic focus and the area causing the aura was performed with protection of motor and language function.
The postoperative course was uneventful. No postoperative deficit was observed. The patient was seizure free during two-year follow up.
Extratemporal resections must be done carefully after determining the seizure focus and the type of seizure. The safe resection boundary is defined with functional mapping. Identification of the primary motor cortex and the language cortex is necessary to avoid motor deficits and speech difficulties respectively.
Keywords : Epilepsy, invasive monitoring, functional mapping