PMC5587238_01
EEG showing a left temporal seizure pattern with a maximum at the left sphenoidal electrode (Sp1) during ictal conduction aphasia in case A [10-20 bipolar montage].
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On discontinuation of anti-seizure medication, two seizures with a left temporal EEG onset at left sphenoidal electrode were recorded (Fig. 1).
Structural MR images (axial T2 and coronal FLAIR) of the left temporal lesion preoperatively (top) and after surgery (bottom) in case A.
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On MRI a left lateral temporal cystic structure was present without signs of hippocampal sclerosis (Fig. 2).
fMRI of a speech paradigm (left side) and DTI-tractography (right side) in case A. On the left side, crosshairs are centred over clusters with maximum correlation to modelled paradigm in the left inferior frontal gyrus ("Broca") and left superior temporal gyrus ("Wernicke").
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Functional MRI and functional transcranial Doppler sonography confirmed a left sided language lateralization (Fig. 3).
Histological image of the left temporal epidermoid cyst in case A. There is a small portion of stratified keratinizing epithelium (arrow) and masses of keratin lamellae in the cyst (asterisk). In the border zone to the surrounding brain lymphocytic infiltrates are found (arrowhead).
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Histologic examination revealed the lesion to be an epidermoid cyst (Fig. 4).
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a. EEG seizure onset in Case B beginning in the left occipital EEG leads (O1/PO3) [10-20 bipolar montage]. b. EEG seizure onset in Case B beginning in the left occipital EEG leads (O1/PO3) [10-20 Fz referenced montage with additional leads in the left occipito-posterior region according to the 10-10 system of electrode placement]. c. The EEG trace in Case B occurred in parallel to the deficits in naming, reading and calculation and shows a left temporo-parieto-occipital seizure pattern (T5/P3/O1), [10-10 Cz referenced montage]. d. Parallel to the left temporo-parieto-occipital seizure pattern (P3 > T5/O1), the patient was still able to follow spoken commands without problems [10-10 Cz referenced montage].
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T5/O1, Fig. 5a-d). The patient showed no signs of interictal speech disturbance or any other neuropsychological deficit that was found during the seizures.
Axial and coronal oriented T2w MR images of the lesion in Case B; T2w hyperintense area (gliosis) in the left occipital and parietal lobes as a postoperative residue after removal of a left tentorial meningioma; part of the posterior horn of the left lateral ventricle is seen on the coronal view directly adjacent to the gliosis due to e vacuo enlargement.
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MRI showed a large post-surgical defect extending from the left temporal to the left occipital lobe including the occipital pole (Fig. 6).