Department of Neurosurgery, Children's Hospital of Fudan University, National Children's Medical Center (Shanghai), Shanghai, 201102, PR China.
Department of Neurology, Children's Hospital of Fudan University, National Children's Medical Center (Shanghai), Shanghai, 201102, PR China.
Seizure. 2021 Mar;86:102-108. doi: 10.1016/j.seizure.2021.01.023. Epub 2021 Feb 10.
This study investigated the role of one-stage stereo-array radiofrequency thermocoagulation based on stereotactic electroencephalography in the treatment of pediatric hypothalamic hamartomas.
We analyzed the clinical data of 28 patients with hypothalamic hamartoma. A high-density focal stereo-array electrode implantation strategy was adopted. Stereotactic electroencephalography guided bipolar coagulations were performed between two contiguous contacts of the same electrode, or between two adjacent contacts of different electrodes. Patients with hypothalamic hamartoma were divided into two groups based on hamartoma size (maximum diameter < 15 mm vs maximum diameter ≥ 15 mm). Numbers of implanted electrodes and contacts used for thermocoagulation were documented. Seizure outcome was evaluated according to Engel's classification.
Surgical procedures were well tolerated and no repeated surgery was performed. The median number of electrodes implanted in the two groups was significantly different (p = 0.0009), as well as the median number of contacts where radiofrequency thermocoagulation was applied (p = 0.0006). Moreover, the number of implanted electrodes and contacts used for thermocoagulation were positively correlated with the hamartoma volume (Spearman's rho = 0.7074, p＜0.0001 and Spearman's rho = 0.7435, p＜0.0001, respectively). The overall seizure-free rate was 82.1 %, with 92.9 % of the patients having favorable outcomes for at least 12 months of follow-up. Seizure outcomes between two groups were not statistically significant (p = 0.3138).
One-stage high-density focal stereo-array stereotactic electroencephalography guided radiofrequency thermocoagulation using cross-bonded electrode contacts for ablation range expansion is a safe and effective surgical approach for children with hypothalamic hamartoma.
本研究探讨了基于立体定向脑电图的单阶段立体阵列射频热凝在小儿下丘脑错构瘤治疗中的作用。
我们分析了 28 例下丘脑错构瘤患者的临床资料。采用高密度焦点立体阵列电极植入策略。立体定向脑电图引导双极凝闭在同一电极的两个相邻触点之间，或两个相邻电极的两个相邻触点之间进行。根据错构瘤大小（最大直径＜15mm 与最大直径≥15mm）将患者分为两组。记录用于热凝的植入电极和触点数量。根据 Engel 分类评估癫痫发作结果。
手术过程均耐受良好，无重复手术。两组中植入电极的中位数数量存在显著差异（p=0.0009），应用射频热凝的触点中位数数量也存在显著差异（p=0.0006）。此外，植入电极的数量和用于热凝的触点数量与错构瘤体积呈正相关（Spearman's rho=0.7074，p＜0.0001 和 Spearman's rho=0.7435，p＜0.0001）。总的癫痫无发作率为 82.1%，92.9%的患者在至少 12 个月的随访中具有良好的结果。两组间的癫痫发作结果无统计学意义（p=0.3138）。
单阶段高密度焦点立体阵列立体定向脑电图引导使用交叉结合电极触点进行消融范围扩展的射频热凝是治疗小儿下丘脑错构瘤的一种安全有效的手术方法。
