Network reprogramming after resection of occipital meningioangiomatosis: Evidence from multimodal localization and longitudinal fMRI

To characterize the epileptic network and postoperative network remodeling in a rare case of right cuneus meningioangiomatosis (MA) with electro-clinical discordance, we integrated electroencephalography (EEG), fluorodeoxyglucose positron emission tomography (FDG-PET), and resting-state fMRI (rs-fMRI). A 16-year-old male with drug-resistant focal impaired-awareness seizures and a right cuneus lesion underwent preoperative multimodal evaluation. Preoperative video-EEG, magnetic resonance imaging (MRI)/computed tomography (CT), and FDG-PET were obtained; gross total resection confirmed MA. Pre- and postoperative rs-fMRI were processed in DPABI. We computed lesion-seed functional connectivity (FC), fractional amplitude of low-frequency fluctuation (fALFF), Regional homogeneity (ReHo), and weighted degree centrality (DC; r > 0.25), then generated post–pre difference maps using Fisher z-transformed data and retained the top 5% of absolute voxel changes (cluster size >50 voxels). Ictal EEG showed onset in the right parieto-occipital region with rapid spread to right temporal and frontal areas. FDG-PET revealed focal hypometabolism in the right cuneus and remote hypometabolism in the right mesial temporal and left central regions. Postoperatively, lesion-based FC decreased in bilateral primary sensorimotor, early visual, and superior temporal/opercular cortices, but increased in the ipsilesional dorsal occipito-parietal network. fALFF and ReHo decreased widely in peri-Rolandic and occipital regions; fALFF and DC increased in medial/superior frontal cortex and bilateral precuneus; DC decreased in inferior frontal opercular/triangular areas. Multimodal findings localized the seizure onset to the right posterior region with widespread propagation. Postoperative rs-fMRI showed network changes consistent with partial normalization, paralleling sustained seizure freedom—though causality cannot be inferred from a single case. • A rare sporadic meningioangiomatosis in the right cuneus is reported. • Multimodal presurgical evaluation resolved the electro-clinical discordance. • Post-resection findings support seizure control via large-scale network reprogramming.