{"id":"ca5aaf4d-690f-42af-86e2-1ef870eb86fe","slug":"network-guided-resection-of-magnetic-resonance-imaging-negative-mesial-temporal-epilepsy-using-gamma-oscillation-regularity-based-transfer-entropy-analysis","title":"Network-guided resection of magnetic resonance imaging-negative mesial temporal epilepsy using gamma oscillation regularity-based transfer entropy analysis","authors":["Yosuke Sato"],"abstract":"Background: Medically refractory, magnetic resonance imaging (MRI)-negative mesial temporal lobe epilepsy presents a diagnostic challenge, often leading to difficulties in localizing the epileptogenic zone and planning effective surgical strategies. Case Description: We present a case in which complementary preoperative and intraoperative electrophysiological analyses identified an occult epileptogenic focus. Preoperative high-density scalp electroencephalogram evaluated with gamma oscillation regularity (GOR) analysis localized a putative epileptogenic region adjacent to the hippocampus. Guided by this localization, intraoperative electrocorticography was analyzed using GOR-based transfer entropy (TE). This mapping revealed a compact hub of consistent outgoing directed information flow localized to the parahippocampal gyrus. The surgical strategy targeted the GOR-based TE-defined parahippocampal focus and its immediate efferent connections while preserving the hippocampus. The patient remains seizure-free with preserved neurocognitive function at follow-up. Conclusion: This case demonstrates that preoperative GOR analysis can noninvasively direct focused intraoperative network interrogation and that GOR-based TE-derived directed connectivity mapping can unmask mesial temporal epileptogenicity in MRI-negative cases, thereby guiding effective, tissue-sparing resections.","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/articles/ca5aaf4d-690f-42af-86e2-1ef870eb86fe/featured/hero-1781557567421.png","publishDate":"2026-05-08T00:00:00.000Z","doi":"10.25259/SNI_56_2026","categories":["Epilepsy","Case Report"],"fullTextUrl":"https://surgicalneurologyint.com/wp-content/uploads/2026/05/14516/SNI-17-276.pdf"}