PMC7270537_01
Post-ATL, pre-ablation coronal T1 MRI without contrast (A). Pre-ablation axial T1 MRI with contrast demonstrating residual hippocampus (B). Intra-operative post-laser catheter placement, pre-ablation MPRAGE axial MRI demonstrates the catheter placed within the residual mesial hippocampus (C). Post-ablation axial T1 MRI with contrast demonstrates enhancement of the ablated residual hippocampus (D). MPRAGE, magnetization-prepared rapid gradient echo.
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Post-operative MR was notable for complete resection of the amygdala and residual posterior hippocampus (Fig. 1A). Repeat MRI confirmed the presence of residual posterior hippocampus (Fig. 1B). T Siemens intraoperative MRI (iMRI) with radial placement error < 1.0 mm (Fig. 1C). An intra-operative T1 post-gadolinium MRI confirmed the ablation of the residual hippocampus (Fig. 1D).
Onset of typical focal impaired awareness seizure demonstrating evolution of 1-3 Hz focal slow activity into theta (6 Hz) activity (A). Inter-ictal focal slowing (1-3) over the left temporal region, maximum at T7 and breach pattern over the same region (B).
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On vEEG, the patient had four typical focal impaired awareness seizures associated with rhythmic theta (5-7 Hz) activity seen maximally over the left posterior temporal region (T7, Fig. 2A). There was also intermittent focal slowing (1-3 Hz) and breach pattern over the left temporal region seen maximally at T7 (Fig. 2B).