Stereo‐EEG–guided radiofrequency thermocoagulations

Abstract

SUMMARYThe rationale and the surgical technique of stereo-electroencephalography (SEEG)-guided radiofrequency thermocoagulation (RF-TC) in the epileptogenic zone (EZ) of patients with difficult-to-treat focal epilepsy are described in this article. The application of the technique in pediatric patients is also detailed. Stereotactic ablative procedures by RF-TC have been employed in the treatment of epilepsy since the middle of the last century. This treatment option has gained new popularity in recent decades, mainly because of the availability of modern imaging techniques, which allow accurate targeting of intracerebral epileptogenic structures. SEEG is a powerful tool for identifying the EZ in the most challenging cases of focal epilepsy by recording electrical activity with tailored stereotactic implantation of multilead intracerebral electrodes. The same recording electrodes may be used to place thermocoagulative lesions in the EZ, following the indications provided by intracerebral monitoring. The technical details of SEEG implantation and of SEEG-guided RF-TC are described herein, with special attention to the employment of the procedure in pediatric cases. SEEG-guided RF-TC offers a potential therapeutic option based on robust electroclinical evidence with acceptable risks and costs. The procedure may be performed in patients who, according to SEEG recording, are not eligible for resective surgery, and it may be an alternative to resective surgery in a small subset of operable patients.

Efficacy of limited hippocampal radiofrequency thermocoagulation for mesial temporal lobe epilepsy

“…In contrast to previous reports on RFTC at various locations, [1][2][3][4]10 in which perilesional edema was obvious on follow-up MRI even 1-3 months after the procedure, our report showed that the area of perilesional edema was very limited at the immediate postoperative MRI follow-up and that the lesion became smaller on MRI at the 3-month follow-up. The major differences may be explained by several possible factors.…”

“…Second, we used a Radionics lead for thermocoagulation, whereas other researchers have used the SEEG leads directly for the RFTC. [2][3][4] During our procedure, depth electrodes were applied first for recording the signal of abnormal discharges to identify the location of the possible seizure onset zone and then switched immediately to a Radionics electrode for target depth and trajectory in the RFTC. In our report, we showed two advantages of immediate recording using leads with stylets, followed by RFTC with Radionics electrodes.…”

Linear and nonlinear interrelations show fundamentally distinct network structure in preictal intracranial EEG of epilepsy patients

“…To improve on this outcome, more accurate localization techniques for the seizure generating tissue are desired. Furthermore, novel forms of tissue removal as thermocoagulation (Cossu et al, ), laser ablation (Drane, ) and high‐intensity focused ultrasound (Quadri et al, ) could benefit even more from increased localization accuracy.…”

Recent Advancement of Technologies and the Transition to New Concepts in Epilepsy Surgery

“…56,59) Although this surgical procedure is remarkably safe, it may be an alternative to resective surgery in a small subset of operable patients. 56,60) Laser interstitial thermal therapy LITT, also known as stereotactic laser ablation (SLA) or laser thermal ablation, is another type of less invasive surgical technique. LITT is being effectively employed with adults and children with temporal lobe or lesional epilepsies across several US epilepsy centers.…”