Radiofrequency-thermoablation: General principle, historical overview and modern applications for epilepsy

Voges, Jürgen; Büntjen, Lars; Schmitt, Friedhelm C.

doi:10.1016/j.eplepsyres.2018.03.007

Cited by 19 publications

(20 citation statements)

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“…[17][18][19][20] Stereotactic thermocoagulation is a minimally invasive technique that has been used for half a century to create precise brain lesions and destroy deep epileptogenic structures, when resective surgery was not feasible. 21 More recently, stereotactic radiofrequency thermocoagulation (RFTC) was performed in patients investigated for drug-resistant epilepsy, using the already implanted SEEG electrodes, as a treatment option for the disconnection of epileptic networks. 8 Initially considered as palliative despite some good responders, the method was reported as safe and well tolerated.…”

Section: Introductionmentioning

confidence: 99%

“…This makes open surgical resection of the insula fraught with risk, despite some recent series reporting reasonable outcomes . Stereotactic thermocoagulation is a minimally invasive technique that has been used for half a century to create precise brain lesions and destroy deep epileptogenic structures, when resective surgery was not feasible . More recently, stereotactic radiofrequency thermocoagulation (RFTC) was performed in patients investigated for drug‐resistant epilepsy, using the already implanted SEEG electrodes, as a treatment option for the disconnection of epileptic networks .…”

Section: Introductionmentioning

confidence: 99%

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Stereotactic thermocoagulation for insular epilepsy: Lessons from successes and failures

et al. 2019

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Objective To assess factors associated with favorable outcome in refractory insular epilepsy treated by volume‐based stereotactic radiofrequency thermocoagulation (RFTC). Methods We performed volume‐based RFTC in 19 patients (11 males, 7‐44 years old). The volume for thermocoagulation was identified by multimodal data including electroencephalography (EEG)‐video, magnetic resonance imaging (MRI), and fluorodeoxyglucose–positron emission tomography (PET) in all patients, and epileptogenic zone (EZ) was assessed by stereo‐electroencephalography (SEEG) in 16. MRI showed insular lesions in four patients (benign tumors, n = 2; focal cortical dysplasia [FCD], n = 1; polymicrogyria, n = 1). MRI was negative in 15 cases; however, PET was positive in 18, and FCD pattern was detected by SEEG in nine cases. The dominant hemisphere was involved in 12 cases. RFTC was performed as a separate procedure after SEEG, or as a single MRI‐guided procedure. The insular volume to be coagulated was determined by a tridimensional identification of the epileptogenic cortex using MRI, PET, and SEEG, and was destroyed with coalescent thermal lesions. Results Seizure‐free outcome was achieved in 10 patients (53%), including Engel class IA in three (follow‐up = 1‐12 years, mean = 5.4). The responder rate (including Engel classes I‐III) was 89%. Transient postoperative deficits (mild hemiparesia, dysarthria, hypoesthesia, dysgeusia) were observed in eight patients (42%), with rapid and total recovery in all but one with persistent mild dysarthria. Neurological deficits were related to higher number of RFTC procedures (P = .036) and greater volume of RFTC (P = .028). Neuropsychological status was unchanged or improved in all; however, psychiatric status transitorily worsened in three patients. Factors contributing to seizure‐free outcome were the detection of FCD pattern (P = .009), localized EZ (P = .038), low RFTC volume (P = .002), low number of RFTC procedures (P = .001), and low RFTC volume/number ratio (P = .012). Optimal volume of RFTC around 2 cm3 offered the best compromise between efficacy and safety. Significance RFTC may be curative in insular epilepsy after accurate localization of EZ with SEEG. Best outcome was associated with low volume of thermolesions.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Stereotactic thermocoagulation for insular epilepsy: Lessons from successes and failures

et al. 2019

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“…SEEG-guided RF-TC is considered as a palliative approach, and its principle often referred to selectively destroying epileptogenic zone or the critical nodes of epileptogenic networks ( 7 ). MR-positive epileptic foci including HH, PNH, and FCD type II ( 11 ) demonstrated satisfactory results after ablation. For MR-negative lesions, especially MR-negative insular lesions, the ablation effect is not satisfactory.…”

Section: Discussionmentioning

confidence: 94%

Magnetoencephalography STOUT Method Adapted to Radiofrequency Thermocoagulation for MR-Negative Insular Epilepsy: A Case Report

Luan

Wang

et al. 2021

Front. Neurol.

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Epilepsy is one of the most challenging neurologic diseases confronted by human society. Approximately 30–40% of the worldwide epilepsy patients are diagnosed with drug-resistant epilepsy and require pre-surgery evaluation. Magnetoencephalography (MEG) is a unique technology that provides optimal spatial-temporal resolution and has become a powerful non-invasive imaging modality that can localize the interictal spikes and guide the implantation of intracranial electrodes. Currently, the most widely used MEG source estimation method for clinical applications is equivalent current dipoles (ECD). However, ECD has difficulties in precisely locating deep sources such as insular lobe. In contrast to ECD, another MEG source estimation method named spatio-temporal unifying tomography (STOUT) with spatial sparsity has particular advantages in locating deep sources. In this case study, we recruited a 5 year-old female patient with insular lobe epilepsy and her seizure recurred in 1 year after receiving the radiofrequency thermocoagulation (RF-TC) therapy. The STOUT method was adopted to locate deep sources for identifying the epileptic foci in epilepsy evaluation. MEG STOUT method strongly supported a stereo-electroencephalographic (SEEG)-guided RF-TC operation, and the patient reported a satisfactory therapeutic effect. This case raises the possibility that STOUT method can be used particularly for the localization of deep sources, and successfully conducted RF-TC under the guidance of MEG STOUT results.

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“…RF lesioning has been a preferred method for intracranial lesioning. Besides, movement disorders and psychiatric disorders surgeries, it has also been used in pain and epilepsy ( Sharim and Pouratian, 2016 ; Voges et al, 2018 ). Lesion size is dependent on the size (diameter) of the electrode, length of the exposed tip, temperature, and duration of the lesion ( Cosman et al, 1983 ).…”

Section: Discussionmentioning

confidence: 99%

Radiofrequency Lesioning for Movement and Psychiatric Disorders-Experience of 107 Cases

Doshi

2021

Front. Hum. Neurosci.

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BackgroundRadiofrequency lesioning (RFL) though used since the 1950s, had been replaced by DBS in the 1990s. The availability of magnetic resonance-guided focused ultrasound for lesioning has renewed the interest in RFL.ObjectiveThis paper analysis RFL in contemporary Functional Neurosurgery for various indications and its outcome. Complication rates of RFL are compared with the same author’s experience of DBS.MethodsOne hundred and seven patients underwent RFL between 1998 and 2019. Indications included Parkinson’s Disease (PD), tremors, dystonia, and obsessive-compulsive disorders (OCD). The surgeries performed include thalamotomy (29), pallidotomy (49), subthalamotomy (23), and anterior capsulotomy/nucleus accumbens lesioning (6). Appropriate rating scales were used for preoperative and postoperative evaluations.ResultsThere was a 25% recurrence rate of tremors for PD after thalamotomy. Writer’s cramp rating scale improved from a mean of 10.54–1.6 in task specific dystonia (TSD) patients, after thalamotomy. In PD patients, after pallidotomy, contralateral motor Unified Parkinson’s Disease Rating Scale (UPDRS) and dyskinesia scores, improved by 41 and 57%, respectively, at 1-year. Burke-Fahn-Marsden Dystonia Rating Scale in hemidystonia patients improved from 18.04 to 6.91, at 1-year. There was 32 and 31% improvement in total and motor UPDRS, respectively, in the subthalamotomy patients, at 2-year. All patients of OCD were in remission. There were three deaths in the pallidotomy group. Postoperative, dysarthria, confusion, hemiparesis, dyskinesia, and paraesthesia occurred in 12 patients, of which, 7 were transient.ConclusionRFL is a useful option in a select group of patients with tremors and dystonia. It is our preferred treatment option for TSD and OCD.

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Radiofrequency-thermoablation: General principle, historical overview and modern applications for epilepsy

Cited by 19 publications

References 19 publications

Stereotactic thermocoagulation for insular epilepsy: Lessons from successes and failures

Stereotactic thermocoagulation for insular epilepsy: Lessons from successes and failures

Magnetoencephalography STOUT Method Adapted to Radiofrequency Thermocoagulation for MR-Negative Insular Epilepsy: A Case Report

Radiofrequency Lesioning for Movement and Psychiatric Disorders-Experience of 107 Cases

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