When the Direct Electrical Cortical Stimulation Failed: A Case Report

Mostafa El Khashab, Wen-Ching Liu, Arno Fried, Theresa M. Gabay, Sean D Pierce, George A Ghacibeh

Abstract


         Direct electrical cortical stimulation is often considered the “gold standard” to identify motor or other eloquent cortices during surgical procedures. However, this method sometimes fails or is insufficient by itself, and the use of other methods can be very helpful in reducing post-operative morbidity. We report the case of a 28-year-old patient who was considered for surgical resection of epileptic focus due to intractable seizure. During surgery both direct electrical stimulation and cortical somatosensory evoked potentials failed to identify the motor and sensory areas for unclear reasons. The surgical plan for resection of his seizure focus was aborted because of its anatomical proximity to the motor strip. Postoperatively, fMRI was performed revealing motor activation at the pre and post central sulcus, which was used as a guide to a successful repeat intraoperative cortical stimulation and resection of the epileptic focus. Functional MRI is a useful tool for identifying motor or other eloquent cortices. During pre-operative planning of neurosurgical procedures involving cortical regions adjacent to eloquent cortex, the use of a multimodal approach can greatly improve accuracy and decrease the risk of post-operative deficits.




doi:10.4021/jnr104e

Keywords


Epilepsy surgery; Eloquent cortex; Functional mapping; Electrical cortical stimulation; fMRI

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