Remote epileptogenic focus detected by electrocorticogram in a case of cavernous angioma

In a case of cavernous angioma, a remote gyrus, which was found to contain an epileptogenic focus by intraoperative electrocorticography (ECoG), was resected simultaneously with lesionectomy. The patient was a 27-year-old male who was referred to our hospital because of frequent systemic tonic-clonic convulsions. ECoG revealed an epileptogenic focus not only in the cortex around the angioma-affected tissue of the left frontal lobe but also in an angioma-free remote gyrus. These epileptogenic foci were removed in addition to lesionectomy. The postoperative course was uneventful. Now (two years after surgery), the patient is seizure-free without any anti-convulsive agent. In the surgical treatment of convulsions-accompanied by cavernous angioma, it is essential not only to detect epileptogenic foci by intraoperative ECoG but also to remove these foci together with the angioma.