Application of radiofrequency thermocoagulation guided by stereotactic electroencephalography in refractory epilepsy

GAO Dandan; GONG Shun; LIU Xiyu; GAO Yang; ZHOU Xu; YUAN Guanqian

Abstract：Objective To explore the role of radiofrequency thermocoagulation(RF-TC)guided by stereoscopic electroencephalography(SEEG)in evaluating prognosis of refractory epilepsy.Methods A retrospective analysis was conducted on the clinical data of 15 patients with refractory epilepsy who underwent RF-TC guided by SEEG in the neurosurgery department of the General Hospital of the Northern Theater Command from January 2021 to June 2022.Aged from 2 to 63 years old,with 10 males and 5 females,these fifteen patients underwent comprehensive long-term video electroencephalography(V-EEG)monitoring,head MRI,PET,and other examinations.Deep electrodes were implanted under the guidance of a robot,and after monitoring the location of seizures,radiofrequency ablation therapy was performed on all patients.Results Cortical electrical stimulation Mapping was performed on these 15 patients before the lesion,and pre lesion was performed on the parts located in the functional area under V-EEG monitoring.The effective output power of pre lesion was 1.1-1.5 W,and the duration was 10-15 s.The rated power for damage was 5-6 W,and the actual effective power output of the electrode working end was 3-3.4 W.The total duration of a single damage was 50 s(including a heating time of 15 s),and the temperature was 72-76℃.The length and diameter of the damaged stove were 7-8 mm and 5-6 mm respectively.Deep thermal condensation damage electrodes(ALCIS,made in France,with a diameter of 0.8 mm,electrode contact length of 2 mm,and contact spacing of 1.5 mm)were used,and adjacent electrodes were damaged.These fifteen patients were followed up for 2-3 years.Eight of them had EngelⅠ-Ⅲgrade after destruction,and seven of them underwent secondary surgical resection after destruction,resulting in Engel Ⅰ-Ⅱ grade after surgery.One patient had EngelⅢ grade after destruction,and medication treatment was adjusted.Conclusions RF-TC guided by SEEG surgery is a precise and safe surgical approach that can reduce epileptic seizures.