Ioannis Karakis, Jay S. Pathmanathan, Mirela V. Simon, Ronan D. Kilbride, Sydney S. Cash, Steven M. Stufflebeam, Andrew J. Cole and Emad N. Eskandar
The practice of epilepsy surgery has largely shifted from invasive investigations with chronic intracranial electrodes to high resolution imaging modalities that may delineate the epileptogenic zone in a non-invasive manner. Nevertheless, non-lesional cases, particularly due to extratemporal cryptic pathology, still pose a major challenge. Here we describe the value of combining traditional electrocorticography with the innovation of 7 Tesla magnetic resonance imaging for the detection of a focal cortical dysplasia and thereby sparing the need for further invasive investigation with chronic intracranial electrodes. We conclude that, especially for extratemporal malformations of cortical development, the use of electrocorticography guided by higher resolution magnetic resonance imaging may effectively delineate the epileptogenic zone and define appropriate resection margins. This highlights theimportance of a multidisciplinary approach and of combined neurophysiologic and imaging techniques in contemporary epilepsy surgery.