Serletis Demitre, Bulacio Juan, Bingaman Justin, Abushanab Elham, Harasimchuk Stephen P, Rammo Richard, Neme-Mercante Silvia, Bingaman William
J Neurosurg Case Lessons. 2023 Aug 14;6(7). doi: 10.3171/CASE23321.
Radiofrequency thermocoagulation (RFTC) during intracranial stereoelectroencephalography (sEEG) was first described as a safe technique for creating lesions of epileptic foci in 2004. Since that time, the method has been applied as a diagnostic and/or palliative intervention. Although widely practiced in European epilepsy surgical programs, the technique has not been popularized in the United States given the lack of Food and Drug Administration (FDA)-approved technologies permitting safe usage of in situ sEEG electrodes for this purpose.
The authors present a case report of a young female patient with refractory left neocortical temporal lobe epilepsy undergoing sEEG electrode implantation, who underwent sEEG-guided RFTC via a stereotactic temperature-sensing pallidotomy probe. Although used as a diagnostic step in her workup, the patient has remained seizure-free for nearly 18 months.
The use of in situ sEEG electrodes for RFTC remains limited in the United States. In this context, this case highlights a safe alternative and temporizing approach to performing diagnostic sEEG-guided RFTC, using a temperature-sensing pallidotomy probe to create small, precise stereotactic lesions. The authors caution careful consideration of this technique as a temporary work-around solution while also highlighting the rising need for new FDA-approved technologies for safe RFTC through in situ temperature-sensing sEEG electrodes.
颅内立体定向脑电图（sEEG）期间的射频热凝术（RFTC）于2004年首次被描述为一种用于创建癫痫病灶损伤的安全技术。从那时起，该方法已被用作诊断和/或姑息性干预措施。尽管在欧洲癫痫手术项目中广泛应用，但鉴于缺乏美国食品药品监督管理局（FDA）批准的允许安全使用原位sEEG电极用于此目的的技术，该技术在美国尚未得到推广。
作者报告了一例患有难治性左侧新皮质颞叶癫痫的年轻女性患者，该患者接受了sEEG电极植入，并通过立体定向温度传感苍白球切开术探头进行了sEEG引导下的RFTC。尽管在其检查过程中用作诊断步骤，但该患者已近18个月无癫痫发作。
在美国，原位sEEG电极用于RFTC的情况仍然有限。在此背景下，该病例突出了一种安全的替代方法和临时方法，即使用温度传感苍白球切开术探头创建小的、精确的立体定向损伤，来进行诊断性sEEG引导下的RFTC。作者提醒，在将该技术作为临时解决方案时需谨慎考虑，同时强调对通过原位温度传感sEEG电极进行安全RFTC的新FDA批准技术的需求日益增加。
