Authors :
Presenting Author: Rei Enatsu, MD, PhD – Sapporo medical university
Aya Kanno, MD, PhD – Sapporo Medical University
Ryohei Saito, MD – Sapporo medical university
Nobuhiro Mikuni, MD, PhD – Sapporo medical university
Rationale:
Traditionally, resective surgery via craniotomy has been performed for epileptic foci. However, this approach is highly invasive and difficult to apply to deep-seated foci. Recently, stereotactic thermo-coagulation has been reported as a less invasive technique.
We report here cases treated with this method at our institution.
Methods:
A coagulation probe is inserted through a burr hole and used to ablate the epileptic focus by applying heat at 74°C for 60 seconds.
Results:
Cases
Case 1: A 12-year-old right-handed male with right occipital lobe epilepsy underwent a resective surgery at age of 11 following invasive monitoring with subdural electrodes. However, seizures persisted postoperatively, and stereotactic thermo-coagulation was performed based on evaluation using stereo-electroencephalography (SEEG). The patient developed left lower quadrant visual field deficit, but seizures have disappeared.
Case 2: A 7-year-old right-handed female with right frontal opercular epilepsy underwent stereotactic thermo-coagulation following SEEG evaluation. She became seizure-free without neurological complications postoperatively.
Case 3: A 37-year-old right-handed female with medial left temporal lobe epilepsy underwent thermo-coagulation of left medial temporal lobe following SEEG and got seizure free.
Case 4: A 31-year-old right-handed male with right temporal lobe epilepsy, resistant to anti-seizure medication, underwent thermo-coagulation of right lateral and medial temporal lobe and achieved seizure free.
Conclusions:
Stereotactic thermo-coagulation is a minimally invasive treatment that can be effective for deep-seated epileptic foci, particularly in cases unsuitable for conventional resective surgery. Accurate delineation of the epileptogenic zone via SEEG is essential for optimal outcomes.
Funding: Takeda science foundation