PMC5451186_01
Neuroimaging and EEG Findings.. (A) Axial FLAIR MRI image and (B) Coronal FLAIR MRI image shows a lesion in the left mid cingulate gyrus (pink) with relation to motor tracks (yellow). (C) Coronal FLAIR MRI image and (D) Sagittal X-ray show placement of depth electrodes. Anterior lesion depth (ALD) was inserted deeper and angled targeting the inferior and lateral aspect of the MRI-visible lesion, with ALD in the lesion on fusion images. Posterior lesion depth (PLD) was inserted shallower and angled targeting the superior and mesial aspect of the MRI-visible lesion. Interhemispheric strips (IHI) were inserted through the inter-hemisphere to cover the MRI lesion in the left cingulate gyrus. (E) Ictal invasive depth EEG (sensitivity 20 uV/mm; time scale 10 mm/s; low frequency filter, 1 Hz; high frequency filter, off) shows onset of seizure with initial rhythmic 2-2.5 Hz sharp and slow waves seen over ALD1 (thick arrow). This was followed by sudden attenuation at ALD with superimposed low amplitude fast activity at ALD 1-4 (thin arrow). (F & G) Post-operative resection and post-operative CT scan. (For interpretation of the references to color in this figure legend, the reader is referred to the web version of this article.)
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Magnetic resonance imaging (MRI) showed a lesion in the left mid cingulate gyrus, which was suspicious for focal cortical dysplasia (Fig. 1). One 6 contact (5 mm inter-electrode distance) strip electrode was inserted into the inter-hemispheric region in contact with the lesion (Fig. 1). Ictal onset was confirmed from the lesion depth electrodes (Fig. 1).