PMC7229485_01
Left anterior frontal resection with preserved language related area.. Resection line (dotted line) and results of functional mapping.. III: third finger, V: fifth finger, SF: superior frontal, MF: middle frontal, IF: inferior frontal, OF: orbitofrontal, T: temporal.. Preoperative and postoperative MRI.
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Magnetic resonance imaging (MRI) showed encephalomalacia with a hemosiderin rim around the left superior frontal sulcus (Fig. 1 upper right). The anterior language area was detected by direct electrical stimulation (rectangular biphasic 50 Hz, 0.2-millisecond pulse width, 1-5-second duration under 7 mA bipolar stimulation) (Fig. 1, left). With consideration of the extent of sustained spikes and the results of functional mapping, we performed the left anterior frontal resection beyond the MRI abnormality (Fig. 1, upper right).
Intracranial EEG showed frequent spikes on the cortex around the cavity, also in the middle and inferior frontal gyri, and the orbitofrontal cortex (A), then continuous spikes in these area caused her unpleasant moods (B). The discharges then gradually spread to the posterior middle and inferior frontal gyri (C). An oral administration of diazepam led to improvement of clinical symptoms and EEG findings over time (D).
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Intracranial EEG showed frequent spikes on the cortex around the cavity, as well as in the middle and inferior frontal gyri, and the orbitofrontal cortex (apparently without symptoms) (Fig. 2A). Subsequently, continuous spikes in these area were seen to coincide with unpleasant moods (Fig. 2B). The discharges then gradually spread to the posterior middle and inferior frontal gyri, at which she showed indifferent face impression, hypokinesia, decreased spontaneous speech, slow verbal response, and dysphasia (Fig. 2C). The clinical symptoms and EEG findings improved by oral administration of diazepam (Fig. 2D).