case_images: PMC8421557_01
case_images: Preoperative magnetic resonance image showing focal cortical dysplasia at the insula, frontal and parietal opercula.
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case_images: Abnormal paroxysmal spike and waves on electroencephalography (EEG) indicated a right temporal lobe focus, which was corroborated by decreased uptake in the right temporal lobe on fluorodeoxyglucose-positron emission tomography (SUVmax: 5.4-6.9 in the right temporal lobe vs 8.5-8.6 in the left temporal lobe) and by magnetic resonance imaging (MRI) findings of insular focal cortical dysplasia (Figure 1).
case_images: Post-operative fluid-attenuated inversion recovery magnetic resonance image showing increased signal intensity in the right insula, which was the epileptogenic region.
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case_images: Repeat MRI showed residual lesions in the operculo-insular area (Figure 2), which were consistent with the abnormal discharges on EEG.
case_images: Pre-radiosurgery coronal (A), axial (B) and zoom out (C) view magnetic resonance images showing residual lesions in the operculo-insular area (within the red rectangles).
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case_images: Surface EEG (Figure 3) and MRI (Figure 4) performed at our hospital during re-evaluation of the patient showed the same findings as those reported previously.
case_images: Pre-radiosurgery interictal electroencephalogram showing sharp waves (within the red circles) in the right temporal-frontal area, which is suggestive of right temporal-frontal epilepsy.
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case_images: Surface EEG (Figure 3) and MRI (Figure 4) performed at our hospital during re-evaluation of the patient showed the same findings as those reported previously.
case_images: Stereotactic radiosurgery plan for the right operculo-insular area in the coronal (A), axial (B) and sagittal (C) views.
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case_images: Informed consent was obtained, and SRS was performed using a linac-based SRS machine with a marginal dose of one fraction of 24 Gy (gross target volume: 6.67 cm3) (Figures 5 and 6).
case_images: Dose-volume histogram of gross target volume and organs at risk.
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case_images: Informed consent was obtained, and SRS was performed using a linac-based SRS machine with a marginal dose of one fraction of 24 Gy (gross target volume: 6.67 cm3) (Figures 5 and 6).