title: The use of electrical source imaging in targeting lesional mesial temporal epilepsy for radiosurgical treatment.
abstract: 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.
authors.affiliation: Department of Neurological and Movement Sciences, Section of Neurology, University of Verona.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Del Felice
authors.affiliation: Neurosurgery Clinic, Department of Neuroscience, University Hospital (AOUI), Verona.
authors.forename: Roberto
authors.initials: R
authors.lastname: Foroni
authors.affiliation: Department of Neurological and Movement Sciences, Section of Neurology, University of Verona,, Department of Neurophysiology, Foundation IRCCS San Camillo Hospital, Venice.
authors.forename: Paolo
authors.initials: P
authors.lastname: Manganotti
authors.affiliation: Department of Neurological and Movement Sciences, Section of Neurology, University of Verona.
authors.forename: Silvia F
authors.initials: SF
authors.lastname: Storti
authors.affiliation: Neuroradiology Clinic, Department of Pathology and Diagnosis, University Hospital (AOUI), Verona, Italy.
authors.forename: Giuseppe K
authors.initials: GK
authors.lastname: Ricciardi
authors.affiliation: Souransky Medical Center, Tel Aviv, Israel.
authors.forename: Dafna Ben
authors.initials: DB
authors.lastname: Bashat
authors.affiliation: Neurosurgery Clinic, Department of Neuroscience, University Hospital (AOUI), Verona.
authors.forename: Michele
authors.initials: M
authors.lastname: Longhi
authors.affiliation: Neurosurgery Clinic, Department of Neuroscience, University Hospital (AOUI), Verona.
authors.forename: Mario
authors.initials: M
authors.lastname: Meglio
authors.affiliation: Neurosurgery Clinic, Department of Neuroscience, University Hospital (AOUI), Verona.
authors.forename: Antonio
authors.initials: A
authors.lastname: Nicolato
mesh_terms: D000328:Adult; D001929:Brain Edema / Q000209:etiology / Q000473:pathology; D004569:Electroencephalography; D004833:Epilepsy, Temporal Lobe / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D016634:Radiosurgery / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome
keywords: epilepsy surgery; high-density EEG; inverse solution problem; radiosurgery