John Libbey Eurotext

The use of electrical source imaging in targeting lesional mesial temporal epilepsy for radiosurgical treatment Volume 16, numéro 4, December 2014


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1 Department of Neurological and Movement Sciences, Section of Neurology, University of Verona,
2 Neurosurgery Clinic, Department of Neuroscience, University Hospital (AOUI), Verona
3 Department of Neurophysiology, Foundation IRCCS San Camillo Hospital, Venice
4 Neuroradiology Clinic, Department of Pathology and Diagnosis, University Hospital (AOUI), Verona, Italy
5 Souransky Medical Center, Tel Aviv, Israel
* Correspondence: Alessandra Del Felice Department of Neurological and Movement Sciences, Section of Neurology, University of Verona, Piazzale LA Scuro, 10, 37134 Verona, Italy

Gamma knife radiosurgery (GK-RS) is a technique applied in selected cases of mesial-temporal epilepsy, although still limited to centres with adequate instrumentation and expertise. Here, we report a case of radio surgery targeted with the aid of electrical source imaging that localizes the cortical area generating the scalp epileptic discharges. The patient, a 39-year-old male, presented with a right mesio-temporal lesion; electrical source imaging localization partially overlapped with the lesional area but showed an important activation of the omolateral frontal area, concordant with the epileptic network. The patient underwent GK-RS, with good neurosurgical and clinical results. A radiosurgical ellipsoidal treatment volume area of 2×2×2 cm3, located over the right temporo-mesial region within a centre showing abnormal signal intensity, was considered. Seven months after treatment, the patient developed brain oedema that gradually resolved after one year. After three years of follow-up, the patient was seizure-free (Engel class I). Our very preliminary experience suggests that electrical source imaging appears to be a useful supporting tool for the definition of the radiosurgical treatment volume in selected patients with temporo-mesial lesional epilepsy.