Stereoelectroencephalography-Guided Radiofrequency Thermocoagulation for Hypothalamic Hamartomas: Preliminary Evidence

Wei, Penghu; An, Yang; Fan, Xiaotong; Wang, Yi-He; Yang, Yanfeng; Ren, Liqiang; Shan, Yongzhi; Zhao, Guoguang

doi:10.1016/j.wneu.2018.03.148

Cited by 37 publications

(32 citation statements)

References 20 publications

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“…Table S1 summarizes the clinical profiles of all 15 patients in which extraoperative recordings were performed. The treatment outcome of RF‐TC on HH for eight of these patients has been previously reported 25 …”

Section: Methodsmentioning

confidence: 99%

“…SEEG‐guided RF‐TC was performed based on the findings of chronic SEEG monitoring in these patients. Technically, RF‐TC lesions were created by the methods previously described 25 . Outcomes were acquired through telephone calls and outpatient visits and further categorized according to Engel's classification.…”

Section: Methodsmentioning

confidence: 99%

“…Although several lesioning techniques for HHs have been proposed, the use of SEEG‐guided radiofrequency‐thermocoagulation (RF‐TC) is increasingly popular due to its high effectiveness and low complication rate. In our hospital, we have developed a multidisciplinary team (MDT) for the treatment of HH‐associated pharmacoresistant epilepsy that privileges the use of SEEG‐guided RF‐TC 25 . All the patients underwent SEEG electrode implantation into the primary target of the HH.…”

Section: Introductionmentioning

confidence: 99%

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Electrophysiological properties and seizure networks in hypothalamic hamartoma

Wang

Shan

Bartolomei

et al. 2020

Ann Clin Transl Neurol

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Objective: Little is known about the intrinsic electrophysiological properties of hypothalamic hamartoma (HH) in vivo and seizure network since only few cases using stereoelectroencephalography (SEEG) electrodes exploring both cortex and HH have been published. To elucidate these issues, we analyzed simultaneous SEEG recordings in HH and cortex systematically. Methods: We retrospectively investigated data from 15 consecutive patients with SEEG electrodes into the HH for the treatment purpose of radiofrequency thermocoagulation treatment. Additional SEEG electrodes were placed into the cortex in 11 patients to assess extra-HH involvement. Interictal discharges within the HH and anatomo-electroclinical correlations during seizures of each patient were qualitatively and quantitatively analyzed. Results: Overall, 77 electrodes with 719 contacts were implanted, and 33 spontaneous seizures were recorded during long-term SEEG monitoring. Interictally, distinct electrophysiological patterns, including isolated intermittent spikes/sharp waves, burst spike and wave trains, paroxysmal fast discharges, periodic discharges, and high-frequency oscillations, were identified within the HH. Notably, synchronized or independent interictal discharges in the cortex were observed. Regarding the ictal discharges, the electrical onset pattern within the HH always started with abrupt giant shifts superimposed on low-voltage fast activity across patients. The gelastic seizure network mainly involved the HH, orbitofrontal areas, and cingulate gyrus. Seizures with automatisms and impaired awareness primarily propagated to mesial temporal lobes. Moreover, independent ictal discharges arising from the mesial temporal lobe were detected in three out of nine patients. Interpretation: This study comprehensively reveals intrinsic electrophysiological patterns and epileptogenic networks in vivo, providing new insights into the mechanisms underlying cortical and subcortical epileptogenesis.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Electrophysiological properties and seizure networks in hypothalamic hamartoma

Wang

Shan

Bartolomei

et al. 2020

Ann Clin Transl Neurol

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“…A specific study about neuropsychological outcome revealed a significant improvement after radiofrequency thermocoagulations [17]. SEEG-guided radiofrequency-thermocoagulation (SEEG-guided RF-TC), a procedure that couples SEEG to radiofrequency coagulations by means of the recording electrodes, has also recently been proposed for hypothalamic hamartoma treatment [18]. However, such an indication requires to be carefully justified, as phase II investigations are usually unnecessary in this specific clinical situation.…”

Section: Hypothalamic Hamartomas: Emergence Of Alternatives To Convenmentioning

confidence: 99%

Malformations of cortical development: New surgical advances

et al. 2019

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Epilepsy related to malformations of cortical development is frequently drug resistant or requires heavy medication, therefore surgery is key in their management. The role of stereotactic surgery has recently changed the diagnosis and treatment of focal cortical dysplasias (FCD), hypothalamic hamartomas (HH) and periventricular nodular heterotopias (PNH). In HH, radiosurgery using Gammaknife ® leads to 60 % of seizure control and is associated with excellent neuropsychological results without significant endocrine function impairment. The seizure control rate is even higher (more than 80 %) with monopolar multiple stereotactic thermocoagulations and Laser interstitial Thermal Therapy (LiTT). While the first technique is associated with a 2 % complications rate (but with excellent neuropsychological outcomes), the latest has up to 22 % side effects in some series. All three of these techniques have encouraging results, but controlled studies are still lacking to provide evidence-based new therapeutic algorithms. With regard to the PNH, surgical management has long been limited by the depth of the lesions and their close anatomical relations with the functional brain connectome. Stereotactic approaches required to perform a SEEG, to locate the part of the PNH responsible for the seizure onset, are later followed by a stereotactic lesioning procedure, therefore doubling the bleeding risk. That is why SEEG-guided radiofrequency-thermocoagulation (SEEG guided-RF-TC), which makes it possible to perform these two steps in a single procedure, was considered as a promising option. A recent meta-analysis confirmed this intuition and reported 38 % of seizure-free patients and 81 % of responders with only 0.3 % of complications, making this approach the first treatment line, followed by LiTT. Among the multiple advances in the FCD identification by non-invasive investigations, a new modality of per-operative diagnostic procedure, the three-dimensional electrocorticography

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“…These complications are more common and severe in giant HHs. In recent years, laser interstitial thermal therapy (LITT) ( 16 , 17 ), MRI-guided stereotactic radiofrequency thermocoagulation (SRT) ( 18 ) and stereo electroencephalography (SEEG)-guided radiofrequency thermocoagulation (RF-TC) ( 19 ) have been introduced for HH ablation. While these minimally invasive treatments have improved seizure outcomes, the ablation volume is limited, with these techniques, especially for RF-TC; typically, the RF-TC ablation diameter is ~3–6 mm around the electrode.…”

Section: Introductionmentioning

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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Stereoelectroencephalography-Guided Radiofrequency Thermocoagulation for Hypothalamic Hamartomas: Preliminary Evidence

Cited by 37 publications

References 20 publications

Electrophysiological properties and seizure networks in hypothalamic hamartoma

Electrophysiological properties and seizure networks in hypothalamic hamartoma

Malformations of cortical development: New surgical advances

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

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