Department of Neurosurgery, Xuanwu Hospital, Capital Medical University (CMU), Beijing, China.
Department of Neurology, Xuanwu Hospital, Capital Medical University (CMU), Beijing, China.
Seizure. 2019 Oct;71:304-311. doi: 10.1016/j.seizure.2019.08.011. Epub 2019 Aug 30.
Concerns about the impact of open surgery for drug-resistant mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS) have driven interest in minimally invasive techniques. Stereo-electro-encephalography guided radiofrequency thermocoagulation (SEEG guided RF-TC) offers an alternative choice but with currently limited efficacy. We developed a procedure for optimally extended thermocoagulative lesions and investigated the efficacy and safety for MTLE-HS in a preliminary observational study.
From June 2016 to August 2017, twenty-two patients were selected for the present study. They met the criteria of unilateral MTLE-HS after noninvasive evaluation and then underwent implantation of a combination of SEEG electrodes to form a high-density focal stereo-array, including one electrode along the long axis of amygdalohippocampal complex and three orthogonal electrodes to widely sample mesial temporal structures. A unilateral epileptogenic zone of mesial temporal structures was confirmed in these 21 patients. SEEG-guided bipolar coagulations were performed between two contiguous contacts of the same electrode, or between two adjacent contacts of different electrodes.
Surgical procedures were well tolerated, with no related complications. At the follow-up of 12 months, 20 patients (95.2%) experienced a >90% decrease in seizure frequency and 16 patients (76.2%) were free of disabling seizures (Engel class I). Among them, eight (38.1%) were classified as Engel class Ia and the other eight (38.1%) as Engel class Ib. Four others (19%) had rare disabling seizures (Engel class II). Only one (4.8%) experienced an Engel class III outcome.
Optimized SEEG-guided RF-TC is a promising complementary option for the treatment of MTLE-HS.
对耐药性海马硬化性内侧颞叶癫痫（MTLE-HS）开颅手术影响的担忧促使人们对微创技术产生了兴趣。立体脑电图引导射频热凝（SEEG 引导 RF-TC）提供了一种替代选择，但目前疗效有限。我们开发了一种优化的扩展热凝固病变的方法，并在一项初步观察性研究中调查了其对 MTLE-HS 的疗效和安全性。
从 2016 年 6 月至 2017 年 8 月，选择了 22 名患者进行本研究。他们符合非侵入性评估后单侧 MTLE-HS 的标准，然后接受了 SEEG 电极的植入，以形成高密度焦点立体阵列，包括一个电极沿着杏仁核-海马复合体的长轴，以及三个正交电极以广泛采样内侧颞叶结构。在这 21 名患者中，单侧内侧颞叶结构致痫区得到了确认。SEEG 引导的双极凝固在同一电极的两个连续触点之间或两个不同电极的两个相邻触点之间进行。
手术过程均耐受良好，无相关并发症。在 12 个月的随访中，20 名患者（95.2%）的癫痫发作频率下降了>90%，16 名患者（76.2%）无致残性癫痫发作（Engel 分级 I）。其中，8 名（38.1%）患者为 Engel 分级 Ia，8 名（38.1%）为 Engel 分级 Ib。另外 4 名（19%）患者有罕见的致残性癫痫发作（Engel 分级 II）。仅有 1 名（4.8%）患者的结果为 Engel 分级 III。
优化的 SEEG 引导 RF-TC 是治疗 MTLE-HS 的一种有前途的补充选择。
