Ultrasound assisted awake epilepsy surgery for type IIB focal cortical dysplasia in eloquent areas.

ABSTRACT

Focal cortical dysplasia (FCD) type IIb is a frequent cause of pharmacoresistant epilepsy. However, intraoperative identification of the pathological tissue still remains a challenge despite the use of neuronavigation, particularly when it lies in eloquent areas. We here report a case of intraoperative identification of a right frontal FCD type IIB through ultrasound assisted neuronavigation during awake surgery in a patient with drug-resistant epilepsy. Intraoperative ultrasound may have a role in focal cortical dysplasia localization optimizing its resection. In selected patient submitted to epilepsy surgery the integration of disposable technologies (i.e. brain neuronavigation, fMRI and iUS) with awake surgery could improve FCD identification preventing unacceptable neurological morbidity.