Posterior occipitotemporal stereoelectroencephalography implantation in a patient with artificial dural reconstruction: A case report
TL;DR
Posterior occipitotemporal trajectories represent a practical alternative for SEEG implantation when conventional approaches are limited by prior cranial reconstruction.
Abstract
Background: Depth electrode implantation is widely used in the presurgical evaluation of drug-resistant epilepsy. Conventional orthogonal temporal trajectories are commonly used to access mesial temporal structures; however, these approaches may be technically challenging in patients with prior cranial surgery or dural reconstruction. Case Description: A 53-year-old woman developed epilepsy following herpes encephalitis at 29 years of age. She previously underwent right frontal lobectomy with artificial dural reconstruction but continued to experience medically refractory seizures. Presurgical evaluation suggested a complex epileptogenic network involving bilateral mesial temporal structures and additional cortical regions. Because a large artificial dural graft and postoperative skull defects limited conventional temporal entry points, all electrodes were implanted using posterior occipitotemporal trajectories. Stereoelectroencephalography (SEEG) monitoring recorded 19 seizures arising from the right hippocampus, right parietal cortex, and left hippocampus. Although multiple seizure onset regions were identified, the right hippocampus was considered the principal surgical target based on seizure frequency and propagation patterns. The patient subsequently underwent right anterior temporal lobectomy with amygdalohippocampectomy and achieved an Engel class II seizure outcome at 6-month follow-up. Conclusion: Posterior occipitotemporal trajectories represent a practical alternative for SEEG implantation when conventional approaches are limited by prior cranial reconstruction.