PMC7297952_01
Magnetic resonance imaging scans of the patient at different ages. (A) Images at 2.5 years of age before the first resective operation the giant HH (about 35 x 32 x 25 mm, images from left to right are the axial contrasted T1 image, axial T2 FLAIRE image, coronal T1 image, and sagittal T1 image). (B) Images at 3.5 years of age after the second resective operation demonstrated about 25% of the lesion had remained (images from left to right are two axial contrasted T1 images in different slices, contrasted coronal T1 image, and contrasted sagittal T1 image). (C) Images 7 days after the ablation showed that almost all the par connection between the HH and the hypothalamus has been coagulated. (Images from left to right are axial, sagittal, and coronal T2 FLAIRE images).
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F1
A giant HH, which was approximately 35 x 32 x 25 mm had grown to the interpeduncular cistern as revealed by an MRI scan (Figure 1A). Both operations were via the same trans-right-frontal-basal approach and about 50% of the lesion had been removed (Figure 1B), and pathological examinations verified the diagnosis of HH. Structural imaging showed that the remaining HH was connected to the hypothalamus (Figure 1B). Post-ablation MRI showed a satisfying ablation of the par connection between the HH and the hypothalamus (Figure 1C).
(A) Scalp VEEG showed seizure onset with the consciousness loss with head-turning to the left was located on the right anterior area with low-voltage fast activities. (B) SEEG demonstrated that inter-ictal discharges emerged only within the temporal lobe (nodes A8-11, B6-7, B11-12, D7-9, and E4-5). (C) SEEG showed that GS started within the right hippocampus (nodes D7-9 and E4-5) with spike-waves in fast activities. Seizure activities were not recorded, either during the inter-ictal period or during the seizure procedure, in nodes within the remaining HH.
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F2
Figure 2A shows the VEEG waveforms of 6 s pre-ictal and 11 s early-ictal period of the second seizure type. Figure 2B shows that SEEGs for all the inter-ictal discharges were located within the temporal lobe (A8-11, B6-7, B11-12, D7-9, and E4-5). Unexpectedly, seizure onsets of the two types, even the GS, originated from the hippocampus (E4-5 and D7-9) with spike-waves in fast activities as shown in Figure 2C.
(A) Fusion images of CT and T1 images demonstrated locations of the electrode nodes. Nodes A1-5, B1-5, C1-3, and D1-4 were located within the remaining HH. E4-5 were located in the right hippocampus that occurred during implantation. (B) The whole procedure of the computational method. More details have been described in a previous study. (C) The results of calculations of the 5 min SEEG data before seizure onset demonstrated that nodes within the remaining HH (nodes B1-2, C1-2, and D3-4) also contained prominent out-degrees, while nodes within the hippocampus (nodes E4-5) contained dominant out-degrees. (D) The results of calculations of the 90 s ictal data showed dominant out-degrees within the hippocampus (nodes E4-5). Numbers in the vertical axis correspond to nodes of the electrodes: 1:14 = A1-2:A14-15; 15:29 = B1-2:B15-16; 30:45 = C1-2:C16-17; 46:61 = D1-2:D16-17; 62:77 = E1-2:E16-17.
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Figure 3A shows all nodes within the remaining HH. Figure 3B shows the analyzing process; more details have been described in our previous study. Thereafter, prominent out-degrees within HH (B1-2, C1-3, and D2-4) were demonstrated in the pre-ictal period (Figure 3C), although the hippocampus (E4-5) persistently showed dominant out-degrees.