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Summary  Epilepsy associated with cavernous malformation ( CM ) often requires surgical resection of seizure focus to achieve seizure‐free outcome. High‐frequency oscillations ( HFO s) in intracranial electroencephalogram ( EEG ) are reported as potential biomarkers of epileptogenic regions, but to our knowledge there are no data on the existence of  HFO s in  CM ‐caused epilepsy. Here we report our experience of the identification of the seizure focus in a 3‐year‐old pediatric patient with intractable epilepsy associated with  CM . The electrocorticographic recordings were obtained from a 64‐contact grid over 2 days in the epilepsy monitoring unit ( EMU ). The spatial distribution of  HFO s and epileptic spikes were estimated from recording segments right after the electrode placement, during sleep and awake states separately. The  HFO  distribution showed consistency with the perilesional region; the location of spikes varied over days and did not correlate with the lesion. The  HFO  spatial distribution was more compact in sleep state and pinpointed the contacts sitting on the  CM  border. Following the resection of the  CM  and the hemosiderin ring, the patient became seizure‐free. This is the first report describing  HFO s in a pediatric patient with intractable epilepsy associated with  CM  and shows their potential in identifying the seizure focus.

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High‐frequency oscillations detected in  EC oG recordings correlate with cavernous malformation and seizure‐free outcome in a child with focal epilepsy: A case report