PMC8421557_01
Preoperative magnetic resonance image showing focal cortical dysplasia at the insula, frontal and parietal opercula.
IMCRJ-14-597-g0001.jpg
PMC8421557_01_IMCRJ-14-597-g0001.jpg
f0001
Abnormal paroxysmal spike and waves on electroencephalography (EEG) indicated a right temporal lobe focus, which was corroborated by decreased uptake in the right temporal lobe on fluorodeoxyglucose-positron emission tomography (SUVmax: 5.4-6.9 in the right temporal lobe vs 8.5-8.6 in the left temporal lobe) and by magnetic resonance imaging (MRI) findings of insular focal cortical dysplasia (Figure 1).
Post-operative fluid-attenuated inversion recovery magnetic resonance image showing increased signal intensity in the right insula, which was the epileptogenic region.
IMCRJ-14-597-g0002.jpg
PMC8421557_01_IMCRJ-14-597-g0002.jpg
f0002
Repeat MRI showed residual lesions in the operculo-insular area (Figure 2), which were consistent with the abnormal discharges on EEG.
Pre-radiosurgery coronal (A), axial (B) and zoom out (C) view magnetic resonance images showing residual lesions in the operculo-insular area (within the red rectangles).
IMCRJ-14-597-g0003.jpg
PMC8421557_01_IMCRJ-14-597-g0003.jpg
f0003
Surface EEG (Figure 3) and MRI (Figure 4) performed at our hospital during re-evaluation of the patient showed the same findings as those reported previously.
Pre-radiosurgery interictal electroencephalogram showing sharp waves (within the red circles) in the right temporal-frontal area, which is suggestive of right temporal-frontal epilepsy.
IMCRJ-14-597-g0004.jpg
PMC8421557_01_IMCRJ-14-597-g0004.jpg
f0004
Surface EEG (Figure 3) and MRI (Figure 4) performed at our hospital during re-evaluation of the patient showed the same findings as those reported previously.
Stereotactic radiosurgery plan for the right operculo-insular area in the coronal (A), axial (B) and sagittal (C) views.
IMCRJ-14-597-g0005.jpg
PMC8421557_01_IMCRJ-14-597-g0005.jpg
f0005
Informed consent was obtained, and SRS was performed using a linac-based SRS machine with a marginal dose of one fraction of 24 Gy (gross target volume: 6.67 cm3) (Figures 5 and 6).
Dose-volume histogram of gross target volume and organs at risk.
IMCRJ-14-597-g0006.jpg
PMC8421557_01_IMCRJ-14-597-g0006.jpg
f0006
Informed consent was obtained, and SRS was performed using a linac-based SRS machine with a marginal dose of one fraction of 24 Gy (gross target volume: 6.67 cm3) (Figures 5 and 6).