Optimized SEEG-guided radiofrequency thermocoagulation for mesial temporal lobe epilepsy with hippocampal sclerosis

Fan, Xiaotong; Shan, Yongzhi; Lü, Chao; An, Yang; Wang, Yihe; Du, Jialin; Wang, Di; Wei, Penghu; Fisher, Robert S.; Wang, Yuping; Ren, Liqiang; Zhao, Guoguang

doi:10.1016/j.seizure.2019.08.011

Cited by 46 publications

(34 citation statements)

References 36 publications

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“…A contiguous bipolar RF-TC using one electrode was considered to be one-dimensional, while RF-TC using coupling contacts from two electrodes in one plane was two-dimensional. Three-dimensional cross-bonding of various electrode contacts provided a novel method to optimize SEEG-guided RF-TC ( 24 ). Through this process, the scope of thermal coagulation was expanded.…”

Section: Methodsmentioning

confidence: 99%

One-Stage High-Density Focal Stereo-Array SEEG-Guided Radiofrequency Thermocoagulation for the Treatment of Pediatric Giant Hypothalamic Hamartomas

et al. 2020

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Background: Giant hypothalamic hamartomas (HHs) are extremely rare lesions, for which the treatment is challenging. While minimally invasive treatments such as radiofrequency thermal coagulation and laser ablation have improved seizure outcomes, multiple operations are often required. This study investigated the value of one-stage stereo-array radiofrequency thermocoagulation based on stereotactic electroencephalography (SEEG) for pediatric giant HHs. Methods: We analyzed the clinical data of six patients with giant HHs (masses with a maximum diameter >30 mm) who underwent stereotactic electrode implantation between November 2017 and April 2019. After a multidisciplinary discussion, we designed a high-density focal stereo-array electrode implantation strategy. SEEG-guided bipolar coagulations were performed between two contiguous contacts of the same electrode, or between two adjacent contacts of different electrodes. Results: Among the six patients, three were male and three were female, with an average age of 5.08 ± 4.73 years (range, 1.4–12 years); the average follow-up duration was 20.17 ± 5.49 months. One patient had previously undergone open surgery. Four patients had gelastic seizures, one had gelastic and tonic seizures, and one had gelastic and generalized tonic-clonic seizures. The number of implanted electrodes ranged from 3 to 7, with an average of 5.33. One patient had transient diabetes insipidus after the operation, and no child had fever or new hormone metabolisms disorder after surgery. Four patients had Engel I classification outcomes (free from disabling seizures), and two patients had Engel II classification outcomes. Conclusion: Although the exploration of epileptic activity and the extent of ablation are limited by the number of SEEG electrodes for the complete disconnection. One-stage high-density focal stereo-array SEEG-guided radiofrequency was safe and effective for treating pediatric giant HH patients. It can be an alternative method to treat giant HHs where LITT is unavailable.

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Section: Methodsmentioning

confidence: 99%

One-Stage High-Density Focal Stereo-Array SEEG-Guided Radiofrequency Thermocoagulation for the Treatment of Pediatric Giant Hypothalamic Hamartomas

et al. 2020

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“…SEEG is considered the “gold standard” method to evaluate the epileptogenic zones for electrodes implanted in the deep brain and can record interictal and ictal epileptic discharges for days before deciding the extent of resection [ 6 , 7 , 8 , 9 ]. Our team at the China International Neuroscience Institute (China-INI) of XuanWu Hospital has also confirmed the value of SEEG in the assessment and guidance of thermocoagulation of epileptogenic foci [ 10 ].…”

Section: Introductionmentioning

confidence: 92%

Computer-Aided Intracranial EEG Signal Identification Method Based on a Multi-Branch Deep Learning Fusion Model and Clinical Validation

et al. 2021

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Surgical intervention or the control of drug-refractory epilepsy requires accurate analysis of invasive inspection intracranial EEG (iEEG) data. A multi-branch deep learning fusion model is proposed to identify epileptogenic signals from the epileptogenic area of the brain. The classical approach extracts multi-domain signal wave features to construct a time-series feature sequence and then abstracts it through the bi-directional long short-term memory attention machine (Bi-LSTM-AM) classifier. The deep learning approach uses raw time-series signals to build a one-dimensional convolutional neural network (1D-CNN) to achieve end-to-end deep feature extraction and signal detection. These two branches are integrated to obtain deep fusion features and results. Resampling is employed to split the imbalanced epileptogenic and non-epileptogenic samples into balanced subsets for clinical validation. The model is validated over two publicly available benchmark iEEG databases to verify its effectiveness on a private, large-scale, clinical stereo EEG database. The model achieves high sensitivity (97.78%), accuracy (97.60%), and specificity (97.42%) on the Bern–Barcelona database, surpassing the performance of existing state-of-the-art techniques. It is then demonstrated on a clinical dataset with an average intra-subject accuracy of 92.53% and cross-subject accuracy of 88.03%. The results suggest that the proposed method is a valuable and extremely robust approach to help researchers and clinicians develop an automated method to identify the source of iEEG signals.

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“…Should the lesioning field be expanded by integrating multiple contacts to coagulate in a network manner, that is, stereo-crossed RF-TC (scRF-TC)? After preliminary albumen and animal investigations, 12 our recent studies have shown that, with this design, seizure outcomes in patients with hypothalamic hamartomas and hippocampal sclerosis were improved without a secondary craniotomy. 8,12 To further quantify the characteristics of scRF-TC that are important to the clinical practice from bed to the bench, it is necessary to address the constraints of albumen as a liquid.…”

Section: Introductionmentioning

confidence: 99%

“…After preliminary albumen and animal investigations, 12 our recent studies have shown that, with this design, seizure outcomes in patients with hypothalamic hamartomas and hippocampal sclerosis were improved without a secondary craniotomy. 8,12 To further quantify the characteristics of scRF-TC that are important to the clinical practice from bed to the bench, it is necessary to address the constraints of albumen as a liquid. Specifically, in the scRF-TC, if the configurations and distances of the deformable electrodes are to be calibrated by holding the electrodes more stably, a semi-solid phantom would be better.…”

Section: Introductionmentioning

confidence: 99%

Stereo-crossed ablation guided by stereoelectroencephalography for epilepsy: comprehensive coagulations via a network of multi-electrodes

Wei

Fan

Wang

et al. 2020

Ther Adv Neurol Disord

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Background: Introducing multiple different stereoelectroencephalography electrodes in a three-dimensional (3D) network to create a 3D-lesioning field or stereo-crossed radiofrequency thermocoagulation (scRF-TC) might create larger lesioning size; however, this has not been quantified to date. This study aimed to quantify the configurations essential for scRF-TC. Methods: By using polyacrylamide gel (PAG), we investigated the effect of electrode conformation (angled/parallel/multiple edges) and electrode distance of creating an electrode network. Volume, time, and temperature were analyzed quantitatively with magnetic resonance imaging, video analysis, and machine learning. A network of electrodes to the pathological left area 47 was created in a patient; the seizure outcome and coverage range were further observed. Results: After the compatibility test between the PAG and brain tissue, the sufficient distance of contacts (from different electrodes) for confluent lesioning was 7 mm with the PAG. Connection to the lesioning field could be achieved even with a different arrangement of electrodes. One contact could achieve at least six connections with different peripheral contacts. Coagulation with a network of electrodes can create more significant lesioning sizes, 1.81–2.12 times those of the classic approaches. The confluent lesioning field created by scRF-TC had a volume of 38.7 cm3; the low metabolic area was adequately covered. The representative patient was free of seizures throughout the 12-month follow up. Conclusion: Lesioning with electrodes in a network manner is practical for adequate 3D coverage. A secondary craniotomy could be potentially prevented by combining both monitoring and a large volume of lesions.

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Optimized SEEG-guided radiofrequency thermocoagulation for mesial temporal lobe epilepsy with hippocampal sclerosis

Cited by 46 publications

References 36 publications

One-Stage High-Density Focal Stereo-Array SEEG-Guided Radiofrequency Thermocoagulation for the Treatment of Pediatric Giant Hypothalamic Hamartomas

One-Stage High-Density Focal Stereo-Array SEEG-Guided Radiofrequency Thermocoagulation for the Treatment of Pediatric Giant Hypothalamic Hamartomas

Computer-Aided Intracranial EEG Signal Identification Method Based on a Multi-Branch Deep Learning Fusion Model and Clinical Validation

Stereo-crossed ablation guided by stereoelectroencephalography for epilepsy: comprehensive coagulations via a network of multi-electrodes

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