Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, 300350, China.
Department of Neurosurgery, Huanhu Hospital, Tianjin University, Tianjin, 300350, China.
Acta Neurochir (Wien). 2024 May 13;166(1):210. doi: 10.1007/s00701-024-06106-x.
To evaluate the safety and efficacy of stereoelectroencephalography (SEEG)-guided radiofrequency thermocoagulation (RFTC) for drug-resistant focal epilepsy and investigate the relationship between post-RFTC remission duration and delayed excision surgery effectiveness.
We conducted a retrospective analysis of 43 patients with drug-resistant focal epilepsy who underwent RFTC via SEEG electrodes. After excluding three, the remaining 40 were classified into subgroups based on procedures and outcomes. Twenty-four patients (60%) underwent a secondary excision surgery. We determined the predictive value of RFTC outcome upon subsequent surgical outcome by categorizing the delayed secondary surgery outcome as success (Engel I/II) versus failure (Engel III/IV). Demographic information, epilepsy characteristics, and the duration of seizure freedom after RFTC were assessed.
Among 40 patients, 20% achieved Engel class I with RFTC alone, while 24 underwent delayed secondary excision surgery. Overall, 41.7% attained Engel class I, with a 66.7% success rate combining RFTC with delayed surgery. Seizure freedom duration was significantly longer in the success group (mean 4.9 months, SD = 2.7) versus the failure group (mean 1.9 months, SD = 1.1; P = 0.007). A higher proportion of RFTC-only and delayed surgical success group patients had preoperative lesional findings (p = 0.01), correlating with a longer time to seizure recurrence (p < 0.05). Transient postoperative complications occurred in 10%, resolving within a year.
This study demonstrates that SEEG-guided RFTC is a safe and potential treatment option for patients with drug-resistant focal epilepsy. A prolonged duration of seizure freedom following RFTC may serve as a predictive marker for the success of subsequent excision surgery.
评估立体定向脑电图（SEEG）引导下射频热凝（RFTC）治疗耐药性局灶性癫痫的安全性和有效性，并探讨术后缓解持续时间与延迟切除手术效果的关系。
我们对 43 例接受 SEF 引导 RFTC 的耐药性局灶性癫痫患者进行了回顾性分析。排除 3 例后，根据手术程序和结果将其余 40 例分为亚组。24 例（60%）患者行二次切除术。我们通过将延迟性二次手术结果分为成功（Engel I/II）和失败（Engel III/IV），来确定 RFTC 结果对后续手术结果的预测价值。评估了患者的人口统计学信息、癫痫特征和 RFTC 后无癫痫发作持续时间。
在 40 例患者中，20%的患者单独接受 RFTC 即达到 Engel Ⅰ级，24 例患者行延迟性二次切除术。总体而言，41.7%的患者联合 RFTC 和延迟性手术达到 Engel Ⅰ级，成功率为 66.7%。成功组的无癫痫发作持续时间明显长于失败组（平均 4.9 个月，SD=2.7 与平均 1.9 个月，SD=1.1；P=0.007）。RFTC 单独和延迟手术成功组术前有病变发现的患者比例更高（p=0.01），与癫痫复发时间较长相关（p<0.05）。术后有 10%的患者发生短暂并发症，在一年内得到解决。
本研究表明，SEEG 引导下 RFTC 是耐药性局灶性癫痫患者的一种安全且有潜力的治疗选择。RFTC 后无癫痫发作持续时间延长可能是后续切除手术成功的预测指标。
