title: Stereo-EEG-guided radiofrequency thermocoagulations.
abstract: The rationale and the surgical technique of stereo-electroencephalography (SEEG)-guided radiofrequency thermocoagulation (RF-TC) in the epileptogenic zone (EZ) of patients with difficult-to-treat focal epilepsy are described in this article. The application of the technique in pediatric patients is also detailed. Stereotactic ablative procedures by RF-TC have been employed in the treatment of epilepsy since the middle of the last century. This treatment option has gained new popularity in recent decades, mainly because of the availability of modern imaging techniques, which allow accurate targeting of intracerebral epileptogenic structures. SEEG is a powerful tool for identifying the EZ in the most challenging cases of focal epilepsy by recording electrical activity with tailored stereotactic implantation of multilead intracerebral electrodes. The same recording electrodes may be used to place thermocoagulative lesions in the EZ, following the indications provided by intracerebral monitoring. The technical details of SEEG implantation and of SEEG-guided RF-TC are described herein, with special attention to the employment of the procedure in pediatric cases. SEEG-guided RF-TC offers a potential therapeutic option based on robust electroclinical evidence with acceptable risks and costs. The procedure may be performed in patients who, according to SEEG recording, are not eligible for resective surgery, and it may be an alternative to resective surgery in a small subset of operable patients.
authors.affiliation: "Claudio Munari" Centre for Epilepsy Surgery, Department of Neuroscience, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Cossu
authors.affiliation: "Claudio Munari" Centre for Epilepsy Surgery, Department of Neuroscience, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Cardinale
authors.affiliation: "Claudio Munari" Centre for Epilepsy Surgery, Department of Neuroscience, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Casaceli
authors.affiliation: "Claudio Munari" Centre for Epilepsy Surgery, Department of Neuroscience, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Castana
authors.affiliation: Department of Pediatric Neurosurgery, Istituto G. Gaslini, Genoa, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Consales
authors.affiliation: "Claudio Munari" Centre for Epilepsy Surgery, Department of Neuroscience, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
authors.forename: Piergiorgio
authors.initials: P
authors.lastname: D'Orio
authors.affiliation: "Claudio Munari" Center for Epilepsy Surgery, Department of Neuroscience, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Lo Russo
mesh_terms: D000293:Adolescent; D001931:Brain Mapping; D002648:Child; D002675:Child, Preschool; D004564:Electrocoagulation / Q000379:methods*; D004569:Electroencephalography; D004827:Epilepsy / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D013238:Stereotaxic Techniques; D016896:Treatment Outcome
keywords: Drug-resistant epilepsy; Epileptogenic zone; Radiofrequency thermocoagulation; Seizure outcome; Stereo-electroencephalography; Stereotactic surgery