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Published on: August 12, 2019
Network reprogramming after resection of occipital meningioangiomatosis: Evidence from multimodal localization and
Changquan Wang1, Bin Chen1, Jing Hong1,2
1Department of Functional Neurosurgery, Comprehensive Epilepsy Unit, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University, School of Medicine, 49 South Chongqing Road, Shanghai, China.
Purpose:
To characterize the epileptic network and postoperative network remodeling in a rare case of right cuneus meningioangiomatosis (MA) with electro-clinical discordance, we integrated electroencephalography (EEG), fluorodeoxyglucose positron emission tomography (FDG-PET), and resting-state fMRI (rs-fMRI).
Methods:
A 16-year-old male with drug-resistant focal impaired-awareness seizures and a right cuneus lesion underwent preoperative multimodal evaluation. Preoperative video-EEG, magnetic resonance imaging (MRI)/computed tomography (CT), and FDG-PET were obtained; gross total resection confirmed MA. Pre- and postoperative rs-fMRI were processed in DPABI. We computed lesion-seed functional connectivity (FC), fractional amplitude of low-frequency fluctuation (fALFF), Regional homogeneity (ReHo), and weighted degree centrality (DC; r > 0.25), then generated post-pre difference maps using Fisher z-transformed data and retained the top 5% of absolute voxel changes (cluster size >50 voxels).
Results:
Ictal EEG showed onset in the right parieto-occipital region with rapid spread to right temporal and frontal areas. FDG-PET revealed focal hypometabolism in the right cuneus and remote hypometabolism in the right mesial temporal and left central regions. Postoperatively, lesion-based FC decreased in bilateral primary sensorimotor, early visual, and superior temporal/opercular cortices, but increased in the ipsilesional dorsal occipito-parietal network. fALFF and ReHo decreased widely in peri-Rolandic and occipital regions; fALFF and DC increased in medial/superior frontal cortex and bilateral precuneus; DC decreased in inferior frontal opercular/triangular areas.
Conclusion:
Multimodal findings localized the seizure onset to the right posterior region with widespread propagation. Postoperative rs-fMRI showed network changes consistent with partial normalization, paralleling sustained seizure freedom-though causality cannot be inferred from a single case.
