“Super-Focal” Cortical Resection in MRI-Negative Epilepsy using Multimodal Imaging-Guided Stereo EEG: A Case Report

Objective: To present an epilepsy surgery case report from the Comprehensive Epilepsy Program (CEP) at Austin Health (Heidelberg, Victoria, Australia). In this case, multimodal imaging-guided stereo EEG allowed for a “super-focal” resection adjacent to eloquent cortex with excellent postsurgical outcome.

Methods: Patient records at the Austin Health were reviewed. Clinical details and investigations were summarized. The patient underwent video EEG monitoring, MRI at 3 and 7 Tesla, MEG, PET, SPECT (ictal and interictal), functional-MRI (EEG-fMRI and resting state functional connectivity) prior to proceeding to invasive monitoring using stereo-EEG and electrical stimulation.

Results: All investigations were reviewed at the Comprehensive Epilepsy Program Meeting at Austin health and a plan was formulated for a very limited parietal corticectomy adjacent to eloquent cortex. The patient underwent surgery without suffering a neurological deficit, and had an excellent outcome (Engel class 1B) at 12 months.

Conclusion: In selected cases, excellent outcomes can be achieved using multimodal imaging guided stereotactically placed invasive EEG monitoring allowing “super-focal” corticectomy in MRI-negative epilepsy.