World neurosurgery 2018 03 29() pii S1878-8750(18)30630-2
The use of magnetic resonance imaging (MRI)-guided ablation methods, such as laser interstitial thermal therapy (LITT) and MRI-guided radiofrequency thermocoagulation (RF-TC) poses the risk of mistreatment in patients with non-epileptic hypothalamic hamartoma (HH). Using stereoelectroencephalography (SEEG)-guided RF-TC could solve this problem. However, there are no reports on the efficacy of this technique. Thus, we examined the safety and efficacy of this method.
This retrospective study was conducted on nine consecutive patients with HH treated between August 2015 and July 2017. All patients received a single round of SEEG-guided RF-TC treatment after comprehensive assessment. The outcome was assessed using Engel’s system. Spearman’s correlation and receiver operating characteristics (ROC) were analyzed to identify potential factors predictive of seizure outcome after an average follow-up duration of 18.78 months.
A total of 20 SEEG electrodes were implanted in nine HH patients, and 73 lesions were created within the tumors. No obvious symptoms were observed during coagulation. Five patients (55.56%) achieved Engel’s class I recovery while the rest (44.44%) achieved Engel’s class II recovery; weight gain was observed in one patient. Correlation analysis revealed a trend of better seizure outcomes for tumors larger in size.
The SEEG signal could guide the ablation of the HH. SEEG-guided RF-TC is a safe procedure and shows promising efficacy. Special attention to the tumor attachment, and multiple rounds of RF-TC might help improve seizure-free rates in the future.