Hexamodal awake brain mapping (language, sensorimotor, ictal, visual, auditory) for multilobar resection in a dominant hemisphere parieto-fronto-temporo-occipital cortical malformation with drug-resistant epilepsy

Surgically remediable epilepsy of the eloquent brain poses the added challenge of preserving function while curing disease. Long-standing epileptogenic lesions have tenacious seizure networks and significant functional reorganizations. Large multilobar lesions may involve multiple functional areas, thereby challenging the limits of functional brain mapping. In this video, the authors describe a dominant hemisphere fronto-parieto-temporo-occipital malformation of cortical development, involving the language, sensorimotor, and visual cortices, placing multiple eloquent cortical and subcortical regions at risk. They illustrate the technique of hexamodal mapping/monitoring involving the language sensorimotor areas, optic radiation, auditory pathway, and ictal irritative zone for a multilobar resection, with good seizure outcome and function preservation. The video can be found here: https://stream.cadmore.media/r10.3171/2024.10.FOCVID24111.