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Ming-Xiang Zou, Jing Li, Xiao-Bin Wang and Guo-Hua Lv

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Xian-Li Lv, You-Xiang Li, Ai-Hua Liu, Ming Lv, Peng Jiang, Jing-Bo Zhang and Zhong-Xue Wu

✓The authors present the case of a patient with a direct carotid artery–cavernous sinus fistula caused by head trauma in whom a self-expanding covered stent was successfully used to obliterate the fistula. However, at the 9-month follow-up an angiogram revealed a complex caroticocavernous fistula that was completely obliterated with Onyx 18 transarterially.

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Ming-Xiang Zou, Guo-Hua Lv, Xiao-Bin Wang and Jing Li

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Hua Zhong, Zhihong Zhou, Guo-Hua Lv, Jing Li and Ming-Xiang Zou

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Jing Xiang, Yingying Wang, Yangmei Chen, Yang Liu, Rupesh Kotecha, Xiaolin Huo, Douglas F. Rose, Hisako Fujiwara, Nat Hemasilpin, Ki Lee, Francesco T. Mangano, Blaise Jones and Ton deGrauw

Object

Recent reports suggest that high-frequency epileptic activity is highly localized to epileptogenic zones. The goal of the present study was to investigate the potential usefulness of noninvasive localization of high-frequency epileptic activity for epilepsy surgery.

Methods

Data obtained in 4 patients, who had seizures during routine magnetoencephalography (MEG) tests, were retrospectively studied. The MEG data were digitized at 4000 Hz, and 3D MR images were obtained. The magnetic sources were volumetrically localized with wavelet-based beamformer. The MEG results were subsequently compared with clinical data.

Results

The 4 patients had 1–4 high-frequency neuromagnetic components (110–910 Hz) in ictal and interictal activities. The loci of high-frequency activities were concordant with intracranial recordings therein 3 patients, who underwent presurgical evaluation. The loci of high-frequency ictal activities were in line with semiology and neuroimaging in all 4 of the patients. High-frequency epileptic activity was highly localized to the epileptogenic zones.

Conclusions

High-frequency epileptic activity can be volumetrically localized with MEG. Source analysis of high-frequency neuromagnetic signals has the potential to determine epileptogenic zones noninvasively and preoperatively for epilepsy surgery.

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Makoto Oishi, Hiroshi Otsubo, Koji Iida, Yasuhiro Suyama, Ayako Ochi, Shelly K. Weiss, Jing Xiang, William Gaetz, Douglas Cheyne, Sylvester H. Chuang, James T. Rutka and O. Carter Snead III

Object

Magnetoencephalography (MEG) has been used for the preoperative localization of epileptic equivalent current dipoles (ECDs) in neocortical epilepsy. Spatial filtering can be applied to MEG data by means of synthetic aperture magnetometry (SAM), and SAM virtual sensor analysis can be used to estimate the strength and temporal course of the epileptic source in the region of interest. To evaluate the clinical usefulness of this approach, the authors compare the results of SAM virtual sensor analysis to the results of ECD analysis, subdural electroencephalography (EEG) findings, and surgical outcomes in pediatric patients with neocortical epilepsy.

Methods

Ten pediatric patients underwent MEG, invasive subdural EEG, and cortical resection for neocortical epilepsy. The authors compared the morphological characteristics, quantity, location, and distribution of the epileptiform discharges assessed using SAM and ECD analysis, and subdural EEG findings (interictal discharges and ictal onset zones).

In nine patients, MEG revealed clustered ECDs. The region exhibiting the maximum percentage (≥ 70%) of spikes/sharp waves on SAM was colocalized to clustered ECDs in seven patients. In six patients, SAM demonstrated focal spikes; in two, diffuse spikes; and in two others, focal rhythmic sharp waves. These epileptiform discharges were similar to those recorded on subdural EEG. In nine patients, concordant regions containing the maximum percentage of spikes/sharp waves were revealed by SAM and subdural EEG data. The region of the maximum percentage of spikes/sharp waves as demonstrated by SAM was colocalized to the ictal onset zone identified by subdural EEG findings in seven patients and partially colocalized in two.

Conclusions

The SAM virtual sensor analysis revealed morphological characteristics, location, and distribution of epileptiform discharges similar to those shown by subdural EEG recordings. By using SAM it is possible to predict intracerebral interictal epileptiform discharges in the region of interest from noninvasively collected preoperative MEG data. The maximum interictal discharge zone identified by SAM virtual sensors correlated to clustered ECDs and the ictal onset zone on subdural EEG findings. Complementary analyses of ECDs and SAM on three-dimensional MR images can improve delineation of epileptogenic zones and lesions in neocortical epilepsy.