Real-time Electrophysiological Monitoring During Seeg-guided Radiofrequency Thermocoagulation
Abstract number :
2.457
Submission category :
9. Surgery / 9C. All Ages
Year :
2024
Submission ID :
1181
Source :
www.aesnet.org
Presentation date :
12/8/2024 12:00:00 AM
Published date :
Authors :
Presenting Author: Jonathan Lau, MD, PhD, FRCSC – Western University, London Ontario Canada
Hellen Kreinter, MD – Western University
Greydon Gilmore, PhD – Western University
Jennifer De Jonge, RET – Western University
Khalid Alorabi, MD – Western University
Giovanni Pellegrino, MD, PhD – Western University
Keith MacDougall, MD – Western University
Jorge Burneo, MD, MSPH, FAAN, FAES, FRCPC – Western University, London Ontario Canada
David Steven, MD, MPH, FRCSC, FACS – Western University
Ana Suller-Marti, MD, PhD – Schulich School of Medicine and Dentistry Western University London Health Sciences Center
Rationale: Stereoelectroencephalography (SEEG)-guided radiofrequency thermocoagulation (RFTC) is a minimally invasive technique that can be coupled with SEEG investigation, and has been demonstrated to reduce the burden of seizures in patients with drug-resistant epilepsy as well as to guide further ablation or resection [1-3]. Protocols and parameters for SEEG-guided RFTC remain unstandardized. One challenge encountered is the limited ability to monitor the procedure at the time of treatment. The authors present a method for real-time electrophysiological monitoring during SEEG-guided RFTC.
Methods:
We conducted a retrospective review of all SEEG cases from December 2022 until December 2023 at the Western Comprehensive Epilepsy Program (London, Ontario, Canada), focusing on patients who underwent SEEG-guided RFTC and simultaneous real-time electrophysiological monitoring.
Real-time electrophysiological monitoring during RFTC was performed using a custom smart cable developed in conjunction with the RF generator manufacturer. All RFTC procedures were performed by the attending neurosurgeon in the presence of a biomedical engineer, EEG Tech, and attended remotely by the epileptologist. We developed a protocol involving confirmation of disconnection of the specific contact(s) being ablated while continued monitoring was feasible for all other electrodes implanted as part of the SEEG investigation.
Results: During this time frame, 59 SEEG procedures were performed with 19 SEEG-guided RFTC procedures performed and recently published [3]. We specifically focus on 12 of whom underwent real-time electrophysiological monitoring at the time of RFTC. The average age was 37.4 years and 50% were women. RFTC always took place at the end of the SEEG investigation. The average number of contacts ablated was 10.8 with 52% of patients noted to be responders (seizure reduction > 50%). One patient had an electrographic seizure during the RFTC recording and underwent re-ablation at the relevant contacts. Monitoring was continued for 10 patients for at least 24 hours following RFTC. Five patients continued to have spikes in the RFTC region suggesting a more diffuse onset zone beyond what could be ablated. Three of these patients underwent an additional RFTC procedure a few days later.
Conclusions:
We performed real-time electrophysiological monitoring during SEEG-guided RFTC, which facilitated safe confirmation of the specific contact(s) to be ablated, valuable as an intraprocedural check. Furthermore, the relative quiescence of pathological spikes could be evaluated in adjacent contacts, and also the evolution of changes at the time of ablation, providing opportunities to optimize RFTC at the time of treatment. To our knowledge, this represents the first experience of performing real-time electrophysiological monitoring during SEEG-guided RFTC and builds evidence for utility in clinical practice.
References
[1] Shields JA et al. Epilepsia. 64: 2081–2093. 2023.
[2] Cossu M et al. Journal of Neurosurgery. 123:1358–1367. 2015.
[3] Kreinter H et al. Epilepsia. epi.18005. 2024.
Funding: Western University Department of Clinical Neurological Sciences Clinician-Researcher Start-up Fund.
Surgery