Fence-post-like Stereoelectroencephalography Electrode-guided Focus Resection Technique: Technical Note

Stereoelectroencephalography electrodes are widely used to identify the epileptogenic zone. When performing resection of the epileptogenic zone identified by intracranial electroencephalography using stereoelectroencephalography electrodes, accurate delineation of the resection boundaries is critical for complete removal while preserving neurological function. However, intraoperative brain shifts often make it difficult to identify the resection boundaries. To address this challenge, we aimed to develop a novel surgical approach, the fence-post-like stereoelectroencephalography electrode-guided focus resection technique, in which implanted stereoelectroencephalography electrodes are used for epileptogenic zone localization and as intraoperative landmarks to guide precise resection. Between April 2021 and December 2024, 4 patients with drug-resistant focal epilepsy underwent stereoelectroencephalography implantation followed by epileptogenic zone resection using the fence-post-like stereoelectroencephalography electrode-guided focus resection technique. In all patients, complete epileptogenic zone resection was achieved, and postoperative seizure outcomes were classified as Engel class I. Regarding complications, one patient experienced slight weakness in the distal upper limb due to resection involving the supplementary motor area; no complications were observed in the remaining patients. The fence-post-like stereoelectroencephalography electrode-guided focus resection technique facilitates accurate and safe epileptogenic zone resection, even in the presence of brain shift, and is expected to contribute to favorable seizure outcomes.