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Optimized SEEG-guided three-dimensional radiofrequency thermocoagulation for insular epilepsy

  • Technical Note - Functional Neurosurgery - Epilepsy
  • Published:
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Abstract

Purpose

The high risk of resection surgery for drug-resistant insular epilepsy has driven interest in new treatment techniques. Stereo-electroencephalography-guided three-dimensional radiofrequency thermocoagulation (SEEG-3D RFTC) offers an alternative option. Herein, we present the detailed protocol and investigation of the efficacy and safety of a preliminary observational study.

Methods

From February 2017 to April 2021, ten patients diagnosed with insular epilepsy were enrolled in the study. They underwent implantation of a combination of SEEG electrodes to form a high-density focal stereo-array in insula, including oblique electrodes through the long axis of insula and orthogonal electrodes to widely cover the medial and lateral insula. SEEG-3D RFTC was performed between two contiguous contacts of the same electrode, or between two adjacent contacts of different electrodes.

Results

Surgical procedures were well tolerated, with no related long-term complications. Seizure-free outcome was achieved in seven patients (70%), including ILAE I in four and ILAE II in three. Two other (20%) patients had rare seizures (ILAE III). One (10%) patient experienced an ILAE IV outcome (follow-up = 12–-63 months). The responder rate (including ILAE I–IV) was 100%.

Conclusion

The optimized SEEG-3D RFTC is an effective and safe option for the treatment of drug-resistant insular epilepsy.

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Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.

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Funding

This research was supported by the National Natural Science Foundation of China (grant numbers 82030037, 81871009, and 81801288); Beijing Municipal Science and Technology Commission (grant number Z161100000516008); Beijing Hospitals Authority Youth Program (grant number QML20190805); and The Translational and Application Project of Brain-inspired and Network Neuroscience on Brain Disorders, Beijing Municipal Health Commission (grant number 11000022T000000444685).

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Authors and Affiliations

  1. Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun St., Xicheng District, Beijing, 100053, China

    Yang Dai, Huaqiang Zhang, Xiaotong Fan, Penghu Wei, Yongzhi Shan & Guoguang Zhao

  2. Clinical Research Center for Epilepsy, Capital Medical University, Beijing, 100053, China

    Yang Dai, Huaqiang Zhang, Xiaotong Fan, Penghu Wei, Yongzhi Shan & Guoguang Zhao

  3. National Clinical Research Center for Geriatric Diseases, Beijing, 100053, China

    Guoguang Zhao

Authors
  1. Yang Dai
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  2. Huaqiang Zhang
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  3. Xiaotong Fan
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  4. Penghu Wei
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  5. Yongzhi Shan
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Contributions

All authors contributed to the study conception and design. Guoguang Zhao conceived and designed the study. Yongzhi Shan contributed to the surgery and provided technical support. Yang Dai conducted the clinical experiments, performed data analysis, interpreted the results, and drafted the manuscript. Huaqiang Zhang drafted and revised the manuscript. Xiaotong Fan and Penghu Wei contributed to the surgery and performed data analysis. All the authors have read and approved the final manuscript.

Corresponding authors

Correspondence to Yongzhi Shan or Guoguang Zhao.

Ethics declarations

Ethical approval

The study has been approved by the Ethics Committee of Xuanwu Hospital, Capital Medical University (approval number NO. LYS [2019] 097), and has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Informed consent

Written informed consent was obtained from all participants.

Conflict of interest

The authors declare no competing interests.

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Yang Dai and Huaqiang Zhang contributed equally to this work as first authors.

This article is part of the Topical Collection on Functional Neurosurgery - Epilepsy

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Dai, Y., Zhang, H., Fan, X. et al. Optimized SEEG-guided three-dimensional radiofrequency thermocoagulation for insular epilepsy. Acta Neurochir 165, 249–258 (2023). https://doi.org/10.1007/s00701-022-05401-9

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  • DOI: https://doi.org/10.1007/s00701-022-05401-9

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