Application Of Stereotactic Electroencephalogram-guided Radiofrequency Thermocoagulation In Refractory Epilepsy

Objective:ROSA robot-assisted deep brain electrode implantation can be used not only for precise localization of epileptic foci by stereotactic electroencephalogram,but also for treatment by SEEG-guided radiofrequency thermocoagulation lesion.This study explored the value of stereotactic electroencephalogram in epilepsy localization and the efficacy and safety of stereotactic electroencephalogram in the treatment of epilepsy.Methods:A retrospective study was conducted to collect drug-refractory epilepsy patients diagnosed and treated by neurosurgery department of the Sixth Medical Center of the General Hospital of the Chinese People’s Liberation Army(formerly the Navy General Hospital)from January 2015 to January 2018.According to inclusion criteria and exclusion criteria,35 patients with intractable epilepsy were selected.General data of these patients were collected,such as age,sex,course of disease,seizure symptoms,frequency of seizures,medication,past surgical history,etc.All patients were treated with cranial MRI,PET-CT and scalp video-EEG before operation.According to the symptoms of seizures,neuroimaging examination and neuroelectrophysiological examination,the implantation pathway of deep brain electrodes was designed on the basis of clinical symptoms-cortical discharge area-anatomy.According to the operation plan,ROSA robot-assisted deep brain electrode implantation was performed under general anesthesia.After the operation,long-term video EEG monitoring was given to capture epileptic discharges.Finally,the EEG results were analyzed by a neuroelectrophysiologist and a neurosurgeon to determine the epileptogenic focus or transmission network.Thermocoagulation was performed according to the epileptic foci and transmission network.The patients weremonitored again for 1 to 2 days after operation to observe whether there was abnormal discharge or not,and multiple lesions could be performed if necessary.After monitoring,the intracranial electrodes were pulled out and antiepileptic drugs continued to be given.After discharge,regular review and follow-up were conducted.Results:251 intracranial electrodes were implanted successfully in 35 patients.All patients had no complications such as intracranial hemorrhage,electrode breakage,electrode failure,cerebrospinal fluid extravasation and so on.Long-term SEEG was performed after operation,and all epileptic foci were successfully located.Radiofrequency thermal ablation was performed according to SEEG results.After RF-TC,1 patient had transient neurological dysfunction and improved after symptomatic treatment such as dehydration and neuronutrition;1 patient had fever and improved after treatment with antibiotics and physical cooling.No complications such as death or permanent neurological dysfunction were found in all patients.The patients were followed up for one year.According to Professor Tan Qifu’s post-operative evaluation plan,8 cases were grade I,10 cases were grade II,5 cases were grade III,7 cases were grade IV and 5 cases were grade V.Conclusions:ROSA robot-assisted stereotactic EEG is a safe,effective and reliable preoperative evaluation method.Radiofrequency thermocoagulation guided by stereotactic EEG is a safe and effective treatment.