Wang Yu-Chi, Cheng Mei-Yun, Hung Po-Cheng, Kuo Cheng-Yen, Hsieh Hsiang-Yao, Lin Kuang-Lin, Tu Po-Hsun, Wu Chieh-Tsai, Hsu Peng-Wei, Wei Kuo-Chen, Chuang Chi-Cheng
Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan.
School of Medicine, Chang Gung University, Taoyuan 333, Taiwan.
J Clin Med. 2022 Aug 17;11(16):4804. doi: 10.3390/jcm11164804.
Repeat craniotomies to treat recurrent seizures may be difficult, and minimally invasive radiofrequency ablation is an alternative therapy. On the basis of this procedure, we aimed to develop a more reliable methodology which is helpful for institutions where real-time image monitoring or electrophysiologic guidance during ablation are not available. We used simulation combined with a robot-assisted radiofrequency ablation (S-RARFA) protocol to plan and execute brain epileptic tissue lesioning. Trajectories of electrodes were planned on the robot system, and time-dependent thermodynamics was simulated with radiofrequency parameters. Thermal gradient and margin were displayed on a computer to calculate ablation volume with a mathematic equation. Actual volume was measured on images after the ablation. This small series included one pediatric and two adult patients. The remnant hippocampus, corpus callosum, and irritative zone around arteriovenous malformation nidus were all treated with S-RARFA. The mean error percentage of the volume ablated between preoperative simulation and postoperative measurement was 2.4 ± 0.7%. No complications or newly developed neurologic deficits presented postoperatively, and the patients had little postoperative pain and short hospital stays. In this pilot study, we preliminarily verified the feasibility and safety of this novel protocol. As an alternative to traditional surgeries or real-time monitoring, S-RARFA served as successful seizure reoperation with high accuracy, minimal collateral damage, and good seizure control.
重复开颅手术治疗复发性癫痫可能具有挑战性，而微创射频消融是一种替代疗法。基于此手术方法，我们旨在开发一种更可靠的方法，这对那些在消融过程中无法进行实时图像监测或电生理引导的机构很有帮助。我们使用模拟结合机器人辅助射频消融（S-RARFA）方案来规划和执行脑癫痫组织损伤。在机器人系统上规划电极轨迹，并使用射频参数模拟时间依赖性热力学。热梯度和边界在计算机上显示，用数学方程计算消融体积。消融后在图像上测量实际体积。这个小样本系列包括1名儿科患者和2名成年患者。残余海马体、胼胝体以及动静脉畸形病灶周围的刺激区均采用S-RARFA进行治疗。术前模拟与术后测量的消融体积平均误差百分比为2.4±0.7%。术后未出现并发症或新的神经功能缺损，患者术后疼痛轻微，住院时间短。在这项初步研究中，我们初步验证了这种新方案的可行性和安全性。作为传统手术或实时监测的替代方法，S-RARFA作为成功的癫痫再次手术，具有高精度、最小的附带损伤和良好的癫痫控制效果。
