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Stereoelectroencephalography-guided radiofrequency thermocoagulation of the epileptogenic zone: a potential treatment and prognostic indicator for subsequent excision surgery

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Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusion

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.

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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 grants from the National Key Research and Development Program of China (NO: 2021YFF1200705).

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Authors and Affiliations

  1. Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, 300350, China

    Chuan Du, Jingtao Yan, Guangfeng Li, Yuzhang Wu & Guangrui Zhao

  2. Department of Neurosurgery, Huanhu Hospital, Tianjin University, Tianjin, 300350, China

    Weipeng Jin, Le Wang, Deqiu Cui & Shaoya Yin

Authors
  1. Chuan Du
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  2. Weipeng Jin
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  3. Le Wang
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  4. Jingtao Yan
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  5. Guangfeng Li
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  6. Yuzhang Wu
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  7. Guangrui Zhao
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  8. Deqiu Cui
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  9. Shaoya Yin
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Contributions

All authors contributed to the study conception and design. Shaoya Yin conceived and designed the study. Weipeng Jin and Le Wang contributed to the surgery and provided technical support. Chuan Du and Yuzhang Wu conducted the clinical experiments, performed data analysis, interpreted the results, and drafted the manuscript. Guangrui Zhao and Deqiu Cui contributed to the surgery. Jingtao Yan and Guangfeng Li and performed data analysis. All the authors have read and approved the final manuscript.

Corresponding author

Correspondence to Shaoya Yin.

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Ethical approval

The study has been approved by the Ethics Committee of Tianjin Huanhu Hospital (approval number NO. 2021–059), and has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Written informed consent was obtained from all participants.

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The authors declare no competing interests.

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Du, C., Jin, W., Wang, L. et al. Stereoelectroencephalography-guided radiofrequency thermocoagulation of the epileptogenic zone: a potential treatment and prognostic indicator for subsequent excision surgery. Acta Neurochir 166, 210 (2024). https://doi.org/10.1007/s00701-024-06106-x

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  • DOI: https://doi.org/10.1007/s00701-024-06106-x

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