When the epileptogenic zone is located very near to, or even with the eloquent cortex, this can be a challenge. In patients with intractable partial epilepsy who are eligible for epilepsy surgery, the best seizure control requires complete resection of the epileptogenic zone. Mots-clés : epilepsy surgery, awake craniotomy, eloquent cortex, cortical stimulation.OUTC: seizure outcome N or n: numbers of patients number in italics refer to patient ( see table 1). MAP: intraoperative cortical mapping SEIZ. Scenario 3 (green arrows ): negative mapping during wakefulness allows resection to proceed: mostly favourable outcome. Scenario 2 (blue arrows ): mapping during wakefulness leads to identification of the language cortex, but allows resection to proceed: intermediate seizure outcome. Scenario 1 (red arrows ): mapping during wakefulness leads to identification of the language cortex, and to change in resection (or abort): unfavourable seizure outcome. Schema displaying the main scenarios encountered in our cohort (the thickness of the arrows is proportional to the number of patients). (D) Brain MRI (T1 sequence) showing postoperative state after complete resection of the FCD. (C) Functional MRI showing language localization to the left side and very close to the area of FCD. (B) Preoperative brain MRI (Flair sequence) showing left frontal FCD. (A) Preoperative brain MRI (T1 sequence) showing left frontal FCD. (C) Postoperative brain MRI (T1 sequence) showing complete resection of the lesion. (B) Functional MRI showing language localization, very close to the lesion. ![]() ![]() (A) Preoperative brain MRI (T1 sequence) showing a lesion (DNET) in the left posterior operculo-insular region. (B) Postoperative brain MRI (T1 sequence) showing a scar from the insular resection. (A) Preoperative brain MRI (T1 sequence) showing no abnormalities.
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