PMC8364341_01
(A) Pre-operative T1-weighted brain MRI sequence co-registered with post-implantation CT showing LPMIH2 electrode (blue arrow) and LMCD depth electrode in close proximity (yellow arrow). (B) Ictal EEG recorded with subdural electrodes demonstrating seizure onset in the posterior interhemispheric electrodes (LPMIH2) with rapid spread to the depth electrodes in the cingulate gyrus (LMCD2). (C) Axial T1-weighted sequences from post-operative brain MRI, showing the focal area of resection in the medial left frontal lobe (cingulate gyrus). (D) H&E stained section shows scattered ballooned/dysplastic neurons in the white matter (arrows), consistent with a diagnosis of focal cortical dysplasia type IIB; magnification @100x.
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F1
After one week of monitoring, to better localize the seizure focus, two depth electrodes were placed into the cingulate gyrus with repositioning of the interhemispheric posterior cingulate strip electrodes for additional coverage (Fig. 1A). Ictal EEG showed onset of the seizure again in the posterior interhemispheric electrodes with rapid spread to the depth electrodes in the cingulate gyrus (Fig. 1B). Post-operative MRI is shown in Fig. 1C. Histological analysis of the resected tissue revealed focal cortical dysplasia type IIB (Fig. 1D).