Lopez Ramos Christian G, Shahin Maryam N, Shafie Beck, Tan Hao, Yamamoto Erin, Rockhill Alexander P, Fecker Adeline, Ismail Mostafa, Cleary Daniel R, Raslan Ahmed, Ernst Lia D
Departments of Neurological Surgery, Oregon Health & Science University, Portland, Oregon, USA.
Departments of Neurology, Oregon Health & Science University, Portland, Oregon, USA.
Stereotact Funct Neurosurg. 2025;103(1):14-23. doi: 10.1159/000541350. Epub 2024 Oct 21.
Complex epilepsy networks with multifocal onset zones that overlap with eloquent cortex may benefit from combined surgical approaches. However, limited data exist on outcomes associated with performing these therapies in tandem. In this case series, we report on 6 patients who underwent combination surgery with either resection or laser interstitial thermal therapy (LITT) and neuromodulation with responsive neurostimulation (RNS) or deep brain stimulation (DBS).
We performed a retrospective review of adult patients with medically refractory epilepsy who underwent staged combination epilepsy surgeries during the same admission at our institution. Six cases treated between 2019 and 2023 were identified. All patients underwent a presurgical work-up including invasive intracranial monitoring and underwent a combined approach with either surgical resection, LITT, RNS, or DBS. We extracted data on demographic, clinical, and surgical characteristics. The primary outcome was change in seizure frequency from baseline.
The mean age was 42.7 years old (4 female). All patients had at least one epileptogenic zone in the temporal lobe, two in extratemporal neocortex, two in periventricular nodular heterotopia. For the staged combination approach, 3 patients underwent LITT followed by RNS, two underwent resection and RNS, and one received LITT and DBS. The mean reduction in seizure frequency per month at last follow-up was 90%. Postoperatively, 1 patient experienced superior visual field deficits related to LITT, and another had postoperative deep vein thrombosis.
All patients experienced at least an 83% reduction in seizures. This case series demonstrates the potential benefits of a combined surgical approach in patients with multifocal seizures and at least one lesion that can be safely resected or ablated. Future prospective studies are warranted.
具有多灶性发作区且与明确皮质重叠的复杂癫痫网络可能受益于联合手术方法。然而，关于同时进行这些治疗的相关结果的数据有限。在本病例系列中，我们报告了6例接受联合手术的患者，这些手术包括切除或激光间质热疗（LITT）以及采用响应性神经刺激（RNS）或深部脑刺激（DBS）进行神经调节。
我们对在我院同一住院期间接受分期联合癫痫手术的药物难治性癫痫成年患者进行了回顾性研究。确定了2019年至2023年期间治疗的6例病例。所有患者均接受了包括侵入性颅内监测在内的术前检查，并采用了手术切除、LITT、RNS或DBS的联合方法。我们提取了有关人口统计学、临床和手术特征的数据。主要结局是癫痫发作频率相对于基线的变化。
平均年龄为42.7岁（4名女性）。所有患者至少有一个颞叶致痫区，两个颞外新皮质致痫区，两个脑室周围结节性异位致痫区。对于分期联合方法，3例患者先接受LITT，然后接受RNS，2例接受切除和RNS，1例接受LITT和DBS。最后一次随访时每月癫痫发作频率的平均降低率为90%。术后，1例患者出现与LITT相关的上视野缺损，另1例出现术后深静脉血栓形成。
所有患者的癫痫发作至少减少了83%。本病例系列证明了联合手术方法对多灶性癫痫发作且至少有一个可安全切除或消融病变的患者的潜在益处。未来有必要进行前瞻性研究。
