Radiofrequency Energy and Electrode Proximity Influences Stereoelectroencephalography-Guided Radiofrequency Thermocoagulation Lesion Size: An In Vitro Study with Clinical Correlation

Staudt, Michael D.; Maturu, Sarita; Miller, Jonathan P.

doi:10.1093/ons/opx291

Cited by 19 publications

(19 citation statements)

References 18 publications

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“…The French national guidelines on SEEG include a section dedicated to SEEG-guided RF-TC and are, to date, the only recommendations published on this topic [40,41]. They slightly differ from the initial description of the technique [18] as more recent laboratory investigations have found that two parameters determine the volume of the lesion: the dipole selection and the radiofrequency parameters [42,43].…”

Section: Radiofrequency Thermocoagulationmentioning

confidence: 99%

Surgical techniques: Stereoelectroencephalography-guided radiofrequency-thermocoagulation (SEEG-guided RF-TC)

Bourdillon

Rheims

Catenoix

et al. 2020

Seizure

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Stereoelectroencephalography-guided radiofrequency-thermocoagulation (SEEG-guided RF-TC) consists of coupling SEEG investigation with RF-TC stereotactic lesioning directly through the recording electrodes. In this systematic review the surgical technique, indications, and outcomes are described. Maximum accuracy is reached when a frame-based procedure with a robotic assistance and a per-operative vascular X-ray imaging are performed. Monitoring of the lesioning procedure based on the impedance, a sharp modification of which indicates that the thermocoagulation has reached its maximum volume, allows the optimization of the lesion size. The first indication concerns patients in whom a SEEG is required to determine whether surgery is feasible and in whom resection is indeed possible. Even if surgery is performed owing to insufficient efficacy of SEEG-guided RF-TC, the procedure remains interesting owing to its high positive predictive value for good outcome after surgery. The second indication concerns patients in whom phase I non-invasive investigations have concluded to surgical contraindication and who may still undergo SEEG in a purely therapeutic perspective (small deep zones inaccessible to surgery and network nodes of large epileptic networks). Lastly, SEEG-guided RF-TC can be considered as a first-line treatment for periventricular nodular heterotopia (PNH). Independently of indication, the overall seizure-free rate is 23% and the responder rate is 58%. The best results are obtained for PNH (38% seizure-free and 81% responders), while the worst results have been reported for temporal lobe-epilepsy in a dedicated study. The overall complication rate is 2.5%. More evidence is needed to help determine the exact place of SEEG-guided RF-TC in the surgical management algorithm.

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Section: Radiofrequency Thermocoagulationmentioning

confidence: 99%

Surgical techniques: Stereoelectroencephalography-guided radiofrequency-thermocoagulation (SEEG-guided RF-TC)

Bourdillon

Rheims

Catenoix

et al. 2020

Seizure

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“…Counterintuitively, larger lesions across electrodes were created at a lower power (3 watts) even if contacts of the two electrodes were 8-12 mm apart. Once a rise in tissue impedance was seen, no further enlargement of the lesion was noted despite the continued application of current for up to 180 s. 27 In the same study, in vivo application revealed similar results. Three patients underwent SEEG-based RF-TC and larger lesions were noted with an application of 3 watts, albeit with more perilesional edema which may not be desirable within or near eloquent regions.…”

Section: Discussionmentioning

confidence: 60%

Radiofrequency Thermocoagulation in Refractory Focal Epilepsy: The Montreal Neurological Institute Experience

Mirza

Hall

2020

Can. J. Neurol. Sci.

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Background: Radiofrequency thermocoagulation (RF-TC) is a minimally invasive ablative option for refractory focal epilepsy. Methods: A retrospective chart review was conducted of all patients who underwent stereoelectroencephalography (SEEG)-guided RF-TC at our institution. Results: Fourteen patients underwent robot-guided electrode implantation and subsequent RF-TC. After RF-TC, one of the three patients with PVNH was seizure free, one had 18 months of seizure freedom (Engel 2b), and one required temporal neocortical/PVNH resection (Engel 1a). One of the four patients with focal cortical dysplasia (FCD) was seizure free (Engel 1a), two attained seizure freedom after resection (Engel 1a and 1b), while one continues to have significant seizures (Engel 4b). One patient with cavernoma and low central area epileptogenic zone (EZ) did not benefit from RF-TC and is planned for resection. Two of the MRI-negative patients achieved seizure freedom for 3 months and 1 year, respectively, subsequently requiring resection (Engel 1a). One remains seizure free at 4 weeks. Three had seizure recurrence immediately (Engel 4b). With RF-TC alone, two patients (14%) achieved Engel 1a, two were seizure free at 1 year, one had 3 months of seizure freedom, while the rest had recurrence immediately or within a few weeks. 7/14 patients underwent secondary interventions after RF-TC. Overall, seven patients achieved Engel 1a or 1b, one each 2b and 3a, and five Engel 4b. Conclusion: At our institution, RF-TC is a safe ablative procedure for refractory focal epilepsy. It can serve as a segue to secondary interventions and appears promising in PVNH cases. Its role in MRI-negative cases is less clear.

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“…22) A recent study suggested the possibility of generating a larger lesion by delivering lower power of current (<3 W), which may contribute to a better outcome in SEEG-guided RF-TC. 59)…”

Section: Seeg-guided Rf-tcmentioning

confidence: 99%

Technical Aspects of SEEG and Its Interpretation in the Delineation of the Epileptogenic Zone

Khoo

Hall

Dubeau

et al. 2020

Neurol. Med. Chir.(Tokyo)

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Stereo-electroencephalography (SEEG) has gained global popularity in recent years. In Japan, a country in which invasive studies using subdural electrodes (SDEs) have been the mainstream, SEEG has been approved for insurance coverage in 2020 and is expected to gain in popularity. Some concepts supporting SEEG methodology are fundamentally different from that of SDE studies. Clinicians interested in utilizing SEEG in their practice should be aware of those aspects in which they differ. Success in utilizing the SEEG methodology relies heavily on the construction of an a priori hypothesis regarding the putative seizure onset zone (SOZ) and propagation. This article covers the technical and theoretical aspects of SEEG, including the surgical techniques and precautions, hypothesis construction, and the interpretation of the recording, all with the aim of providing an introductory guide to SEEG.

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Radiofrequency Energy and Electrode Proximity Influences Stereoelectroencephalography-Guided Radiofrequency Thermocoagulation Lesion Size: An In Vitro Study with Clinical Correlation

Abstract: Radiofrequency lesions produced using low-energy delivery between SEEG electrodes in close proximity can produce a large lesion. These findings might have advantages for treatment of focal epilepsy.

Cited by 19 publications

References 18 publications

Surgical techniques: Stereoelectroencephalography-guided radiofrequency-thermocoagulation (SEEG-guided RF-TC)

Surgical techniques: Stereoelectroencephalography-guided radiofrequency-thermocoagulation (SEEG-guided RF-TC)

Radiofrequency Thermocoagulation in Refractory Focal Epilepsy: The Montreal Neurological Institute Experience

Technical Aspects of SEEG and Its Interpretation in the Delineation of the Epileptogenic Zone

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