Bottan Juan S, Almalki Fuad, Nabavi Nouri Maryam, Lau Jonathan C, Iansavichene Alla, Gilmore Greydon, Miller Michael, de Ribaupierre Sandrine, Andrade Andrea V
Division of Neurosurgery, Hospital Pedro de Elizalde, Buenos Aires, Argentina; Department of Neurosurgery, Hospital Alemán, Buenos Aires, Argentina.
Department of Paediatrics, College of Medicine, Majmaah University; Department of Paediatrics, Western University, London, ON. Canada.
Seizure. 2025 Mar;126:6-13. doi: 10.1016/j.seizure.2025.01.012. Epub 2025 Jan 13.
To conduct a systematic review on radiofrequency thermocoagulation (RF-TC) in pediatric epilepsy surgery. In addition, due to the low number of dedicated pediatric series, to conduct a pooled analysis of cases published in the literature.
We conducted a literature search using PUBMED and EMBASE which produced 432 results. We excluded studies on hypothalamic hamartomas and non-RF-TC procedures such as stereotactic radiosurgery and laser interstitial thermal ablation. Stereotactic RF-TC and SEEG-guided RF-TC procedures were included. Case series and case reports with individualized data were further reviewed and pediatric cases were extracted for pooled analysis. Patient demographics, electroclinical and neuroimaging data, procedure outcomes, responder rates and complications were collected. Our unpublished experience in pediatric SEEG-guided RF-TC was included in the pooled analysis.
We identified 33 articles for the literature review, 24 of them were selected for pooled analysis (93 cases). Sixty patients underwent SEEG-guided RF-TC. For adult and pediatric mixed series reported a 67% responder rate and 32% seizure freedom at 1 year. For exclusively pediatric series, 90% responder rate and 71% Seizure freedom. In the pooled analysis, seizure freedom was achieved in 45.2% and responder rate was 74.2% with a mean follow-up was 25.2 months (SD ± 26.6). Complication rates were low, transient neurological deficits were reported in 18 cases (19.4%) and no deaths were associated with RF-TC. The insula and the dominant frontal lobe were the most frequent targets for ablation. Studies included were highly heterogenous and quality of evidence was low.
There are few pediatric studies evaluating RF-TC. Safety and efficacy in children seem to be similar to that reported in larger adult series, although more studies are needed. Most cases reviewed where extracted from heterogeneous adult and pediatric series. Patients with small, high-risk surgical targets are ideal candidates for this procedure.
对小儿癫痫手术中的射频热凝术（RF-TC）进行系统评价。此外，由于专门针对儿童的系列研究数量较少，对文献中发表的病例进行汇总分析。
我们使用PUBMED和EMBASE进行文献检索，共获得432条结果。我们排除了关于下丘脑错构瘤和非RF-TC手术（如立体定向放射外科和激光间质热消融）的研究。纳入立体定向RF-TC和SEEG引导下的RF-TC手术。对具有个体数据的病例系列和病例报告进行进一步审查，并提取儿科病例进行汇总分析。收集患者的人口统计学、电临床和神经影像学数据、手术结果、缓解率和并发症。我们未发表的小儿SEEG引导下RF-TC的经验也纳入了汇总分析。
我们确定了33篇文章进行文献综述，其中24篇被选入汇总分析（93例）。60例患者接受了SEEG引导下的RF-TC。对于成人和儿童混合系列，1年时缓解率为67%，癫痫发作自由度为32%。对于仅儿童系列，缓解率为90%，癫痫发作自由度为71%。在汇总分析中，癫痫发作自由度为45.2%，缓解率为74.2%，平均随访时间为25.2个月（标准差±26.6）。并发症发生率较低，18例（19.4%）报告有短暂性神经功能缺损，且无与RF-TC相关的死亡病例。岛叶和优势额叶是最常见的消融靶点。纳入的研究具有高度异质性，证据质量较低。
评估RF-TC的儿科研究较少。儿童的安全性和有效性似乎与较大的成人系列报道相似，尽管还需要更多的研究。大多数回顾的病例来自异质性的成人和儿童系列。手术靶点小、风险高的患者是该手术的理想候选者。
