Seizing Control: Primary Visual Cortex Epilepsy Treated With Resection and Responsive Neurostimulation: 2-Dimensional Operative Video

Abstract

Occipital lobe epilepsy is a debilitating condition, and surgical resection has been effective, though challenges arise because of the cortex's function. 1-7 Approximately 57% of patients with normal vision experience new visual field deficits postoperatively. 8 A combined approach of resection and responsive neurostimulation (RNS) could aid in decreasing the visual field area severed and the disability tied to it while obtaining seizure freedom. 9,10 We aimed to present a case of medically refractory occipital lobe epilepsy with involvement of the primary visual cortex treated with a combined approach. The patient consented to the procedure and to the publication of his image. Any identifiable individuals consented to publication of his/her image. A 21-year-old right-handed male experienced refractory epilepsy since age 1 year. His first seizure was a severe refractory status epilepticus which resulted in cardiac arrest. His usual seizure semiology exhibited focal impaired awareness to bilateral tonic-clonic seizures occurring monthly. Noninvasive tests did not provide precise localization, but the intracranial electroencephalogram confirmed seizure onset in the right cuneus with rapid spread to the lingual gyrus and the superior parietal lobe. We performed a corticectomy 11 of the seizure onset zone and used RNS to address spreading areas in the parietal and occipital lobe. A complete lobectomy was avoided to prevent postoperative homonymous hemianopsia in a previously intact patient. The patient was discharged on postoperative day 3 with a nondisabling left inferior quadrantanopia. No clinical seizures were detected after RNS was turned on, rendering so far 8.5 months of seizure freedom. The combined surgical approach appears promising for medically refractory epilepsy involving functional areas.