Faculty Opinions recommendation of Optimization and high-density array of stereoelectroencephalography-guided radiofrequency thermocoagulation for the treatment of pediatric tuberous sclerosis complex with epilepsy.
This paper describes a two-stage stereoelectroencephalography (sEEG)-guided radio frequency (RF) ablation in children 3-16 years old (n=9) with drug-resistant epilepsy due to tuberous sclerosis. The tumor size ranged from 1.2cm to 3.95cm, visible in the MRI. The first stage sEEG located the pathogenic nodules, mapped functional cortical areas that couldn’t be ablated without causing functional deficits, and coagulated most nodules. The number of coagulations per patient was 1-13. The second stage sEEG was performed in four children who still had seizures, at an interval of 10 days to 13 months. Multiple sEEG electrodes were implanted according to the size, shape, and location of pathogenic nodules identified in the first stage. The electrodes were implanted to form a high-density three-dimensional cross-bonding to cover a sufficiently large ablation volume, necessary for the elimination of the nodules. The outcome was that seven of the nine children were seizure-free; two were still experiencing seizures at the last follow-up. This paper established the feasibility of ablations using sEEG electrodes specifically implanted to cover large volumes. In many countries, ablations for tuberous sclerosis are typically performed using laser interstitial thermal therapy (LITT), which produces large volume ablations. The procedure involves expensive equipment, a laser, and MRI. In countries where resources are scarce and the availability of lasers and MRI suites is reduced, the method described in this paper provides a good alternative with favorable outcomes.