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Updated: May 2, 2026
Author Spotlight: Advancing Pediatric Epilepsy Surgery in Children Through Novel Biomarkers and Enhanced Localization
Published on: September 20, 2024
A novel technique of detecting MRI-negative lesion in focal symptomatic epilepsy: intraoperative ShearWave
Huan Wee Chan1, Ronit Pressler, Christopher Uff
1Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, London, United Kingdom; Joint Department of Physics, Institute of Cancer Research, Sutton, Surrey, United Kingdom.
Abstract:
Focal symptomatic epilepsy is the most common form of epilepsy that can often be cured with surgery. A small proportion of patients with focal symptomatic epilepsy do not have identifiable lesions on magnetic resonance imaging (MRI). The most common pathology in this group is type II focal cortical dysplasia (FCD), which is a subtype of malformative brain lesion associated with medication-resistant epilepsy. We present a patient with MRI-negative focal symptomatic epilepsy who underwent invasive electrode recordings. At the time of surgery, a novel ultrasound-based technique called ShearWave Elastography (SWE) was performed. A 0.5 cc lesion was demonstrated on SWE but was absent on B-mode ultrasound and 3-T MRI. Electroencephalography (EEG), positron emission tomography (PET), and magnetoencephalography (MEG) scans demonstrated an abnormality in the right frontal region. On the basis of this finding, a depth electrode was implanted into the lesion. Surgical resection and histology confirmed the lesion to be type IIb FCD. A PowerPoint slide summarizing this article is available for download in the Supporting Information section here.
Insights
ShearWave Elastography (SWE) identified a small brain lesion in a patient with epilepsy invisible to MRI. This novel technique aided in diagnosing focal cortical dysplasia (FCD) and guiding successful surgical treatment.
Area of Science:
- Neurology
- Medical Imaging
- Neurosurgery
Background:
- Focal symptomatic epilepsy is common and often surgically treatable.
- A subset of patients lack identifiable lesions on MRI, frequently having type II focal cortical dysplasia (FCD).
- Type II FCD is a malformative brain lesion linked to drug-resistant epilepsy.
Observation:
- A patient with MRI-negative focal symptomatic epilepsy underwent invasive electrode recordings.
- ShearWave Elastography (SWE), an ultrasound technique, detected a 0.5 cc lesion.
- This lesion was not visible on B-mode ultrasound or 3-Tesla MRI.
Findings:
- EEG, PET, and MEG scans indicated an abnormality in the right frontal region.
- A depth electrode was implanted into the SWE-detected lesion.
- Histology confirmed the lesion as type IIb FCD, leading to successful surgical resection.
Implications:
- SWE can detect otherwise invisible lesions in MRI-negative epilepsy cases.
- This technique offers a potential new diagnostic tool for focal cortical dysplasia.
- Improved lesion detection may enhance surgical outcomes for epilepsy patients.
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