Images in Neurosurgery

A 25-year-old right-handed gentleman has suffered from epilepsy since the age of two. He experienced two complex partial seizures each month despite maximal medical treatment. Preoperative imaging demonstrated isolated mesial temporal sclerosis (Figure 1), and electroencephalography demonstrated clear anterior temporal onset of his seizures.

The patient underwent a stereotactic laser amygdalohippocampectomy (SLAH) through a 3 mm craniotomy. Postoperative imaging demonstrated a rim-enhancing cavity with little or no edema (Figure 2). A volumetric analysis with three-dimensional reconstructions clearly illustrates the volume of hippocampus ablated with SLAH (Figure 3).

Follow-up imaging demonstrates the development of a non-enhancing cavity after approximately six months (Figures 4-5). The patient has been seizure-free for more than one year after the ablation.

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Submitted by:
Chengyuan Wu, MD, MSBmE
Richard J. Gorniak, MD
Ashwini D. Sharan, MD