title: Lesion guided stereotactic radiofrequency thermocoagulation for palliative, in selected cases curative epilepsy surgery.
abstract: BACKGROUND
  Resective epilepsy surgery is an established treatment option in patients with pharmacoresistant, lesion related epilepsy. Yet, if the presurgical work-up proves multi-focal organization of the epileptogenic zone, or the area of intended resection is close to eloquent brain areas, patients may decide against resections because of an unfavorable risk-benefit-ratio. We assess if lesion guided cortical stereotactic radiofrequency thermocoagulation (L-RFTC) is a potential surgical alternative in these patients.
  
  
  METHODS
  We performed seven procedures of L-RFTC. Three patients had monofocal epilepsy arising close to eloquent structures; in four, invasive pre-surgical workup documented monofocal seizure onset but strong interictal epileptic activity also independent and distant from the seizure onset zone. L-RFTC was restricted to the lesional area (=seizure onset site).
  
  
  RESULTS
  12 to 37 months after RFTC worthwhile seizure improvement was achieved in 6 patients. One patient became seizure free following complete coagulation of a focal cortical dysplasia, two had had 1-2 auras under tapered but not under continued medication. In one patient only subclinical seizures persisted. In one patient hypermotor seizures were transformed into milder short tonic seizures and another one had a seizure reduction by 50%. Only one patient did not profit at all. One patient developed a persisting neurological deficit.
  
  
  CONCLUSIONS
  In patients with complex epileptogenic zones L-RFTC can lead to worthwhile seizure reduction. This qualifies this procedure as a palliative surgical technique with potential good risk-benefit ratio. In patients with small focal cortical dysplasias L-RFTC may even allow minimal-invasive surgery with curative intention.
authors.affiliation: Ruhr-Epileptology, Department of Neurology, University Hospital Knappschaftskrankenhaus, In der Schornau 23-25, 44892 Bochum, Germany. Electronic address: joerg.wellmer@kk-bochum.de.
authors.forename: Jörg
authors.initials: J
authors.lastname: Wellmer
authors.affiliation: Department of Neurosurgery, University Hospital Knappschaftskrankenhaus, In der Schornau 23-25, 44892 Bochum, Germany.
authors.forename: Yaroslav
authors.initials: Y
authors.lastname: Parpaley
authors.affiliation: Ruhr-Epileptology, Department of Neurology, University Hospital Knappschaftskrankenhaus, In der Schornau 23-25, 44892 Bochum, Germany; Department of Neurosurgery, University of Erlangen, Schwabachanlage 6, 91054 Erlangen, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Rampp
authors.affiliation: Ruhr-Epileptology, Department of Neurology, University Hospital Knappschaftskrankenhaus, In der Schornau 23-25, 44892 Bochum, Germany.
authors.forename: Stoyan
authors.initials: S
authors.lastname: Popkirov
authors.affiliation: Department of Clinical Radiology, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany.
authors.forename: Harald
authors.initials: H
authors.lastname: Kugel
authors.affiliation: Institute for Biomagnetism and Biosignalanalysis, Westfalian Wilhelms-University Münster, Malmedyweg 15, 48149 Münster, Germany.
authors.forename: Ümit
authors.initials: Ü
authors.lastname: Aydin
authors.affiliation: Institute for Biomagnetism and Biosignalanalysis, Westfalian Wilhelms-University Münster, Malmedyweg 15, 48149 Münster, Germany.
authors.forename: Carsten H
authors.initials: CH
authors.lastname: Wolters
authors.affiliation: Department of Neurosurgery, University Hospital Knappschaftskrankenhaus, In der Schornau 23-25, 44892 Bochum, Germany.
authors.forename: Marec
authors.initials: M
authors.lastname: von Lehe
authors.affiliation: Department of Stereotactic Neurosurgery, Otto-von-Guericke University, Leipziger Str. 44, 39120 Magdeburg, Germany; Leibniz Institute for Neurobiology, Brenneckestraße 6, 39118 Magdeburg, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Voges
mesh_terms: D000328:Adult; D004564:Electrocoagulation / Q000379:methods*; D004569:Electroencephalography; D004827:Epilepsy / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging; D008297:Male; D054220:Malformations of Cortical Development / Q000209:etiology / Q000628:therapy*; D008875:Middle Aged; D010166:Palliative Care; D013238:Stereotaxic Techniques; D016896:Treatment Outcome
keywords: Epilepsy surgery; Epileptogenic lesion; Minimal invasive; Stereotactic radiofrequency thermocoagulation