Seizure Freedom After Focal Epilepsy Surgery in a Child With Tuberous Sclerosis Complex and Coexisting Suspected Subependymal Giant Cell Astrocytoma: A Case Report

We report a three-year-old girl with tuberous sclerosis complex and drug-resistant focal epilepsy who achieved clinical seizure freedom after left frontal resection.Seizures began at three months of age and continued despite multiple antiseizure medications, occurring approximately 11-16 times daily.Medical records reported a TSC1 mutation, although the original genetic report was unavailable.Preoperative examination documented developmental delay, absence of spoken language and independent walking, and right-sided hemiparesis graded 4/5.Magnetic resonance imaging demonstrated multiple cortical and subcortical lesions, a prominent left frontal abnormality, and a separate right lateral ventricular lesion considered radiologically suggestive of a subependymal giant cell astrocytoma.Presurgical videoelectroencephalography recorded multiple focal motor seizures and subclinical seizure patterns associated with left frontal activity at F3-C3, together with interictal discharges in the same region.Following multidisciplinary assessment, microsurgical resection was performed using neuronavigation, intraoperative neurophysiological monitoring, and bipolar stimulation before resection.Intraoperative electrocorticography was not performed.The subsequent neurosurgical record reported the histological diagnosis of the resected frontal specimen as giant cell astrocytoma, grade I; the original pathology report and slides were unavailable for independent review.The separate ventricular lesion remained unresected.At 18-month follow-up, no clinical seizures had been reported since surgery while antiseizure treatment continued.Independent walking and syllabic speech had emerged, although developmental impairment remained.Right-sided hemiparesis was graded 4/5 both before surgery and at follow-up; the intervening postoperative motor course was incompletely documented.Follow-up electroencephalography demonstrated epileptiform activity despite clinical seizure freedom.This case illustrates a favorable seizure outcome after localized surgery in a child with multiple intracranial lesions, while emphasizing the distinction between clinical seizure control, electroencephalographic findings, and reported pathological diagnoses.