Low-Cost 3D Volume Rendering–Assisted Localization of Perirolandic Focal Cortical Dysplasia: A Case Series with Seizure Outcomes

Objective: To evaluate the feasibility and clinical utility of a low-cost three-dimensional volume rendering (3D VR) technique for intraoperative localization of perirolandic focal cortical dysplasia (FCD) in drug-resistant epilepsy (DRE), with emphasis on seizure outcomes. Background: Surgical management of perirolandic FCD is constrained by the need for precise localization within eloquent cortex. Conventional neuronavigation systems are often unavailable in resource-limited settings. 3D VR reconstruction of routine imaging data sets offers a pragmatic alternative for preoperative planning and intraoperative guidance. Methods: We performed a retrospective analysis of consecutive patients with DRE due to perirolandic FCD undergoing resective surgery. Preoperative planning utilized 3D VR reconstruction generated on RadiAnt software (Windows platform), enabling simulation of craniotomy, cortical surface mapping, and anatomical correlation. All patients underwent electrocorticography-guided resection. Demographic, clinical, imaging, operative, and outcome data were analyzed. Descriptive statistics are reported. Results: Six patients (mean age 14.8 ± 8.3 years; range 5–28 years) were included. 3D VR planning enabled accurate surface localization in all cases and facilitated tailored craniotomy and cortical mapping. Gross total resection was achieved in 100% (6/6), confirmed on postoperative magnetic resonance imaging. There were no major perioperative complications; transient neurological deficits occurred in 2/6 (33.3%) and resolved on follow-up. Postoperative electroencephalography demonstrated absence of epileptiform discharges in all patients. At a mean follow-up of 21 ± 6 months, all patients achieved Engel class I outcome (100%), with complete seizure freedom (Engel IA in 5/6, IB in 1/6). Conclusion: 3D VR-based planning using readily available software is a feasible, low-cost adjunct for localization of perirolandic FCD, enabling safe resection with excellent seizure outcomes. This technique may serve as an effective alternative to conventional neuronavigation in selected cases, particularly in resource-constrained settings. Publication History Article published online: 15 July 2026 © 2026. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/) Thieme Medical and Scientific Publishers Private Limited A-13A, Graphix Tower 1, 6th floor, Sector 62, Noida 201309, Uttar Pradesh, India