Stereo-EEG for Epileptogenic Focus Localization in Schizencephaly: A Single-center Experience in Four Patients

• Published in: World neurosurgery Vol. 172; pp. e319 - e325
• Main Authors: Liu, Ping-Chuan, Chen, Hsin-Hung, Chou, Chien-Chen, Chen, Ching-Jen, Chen, Yi-Hsiu, Lin, Chun-Fu, Chen, Chien, Yu, Hsiang-Yu, Lee, Cheng-chia
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2023
• Subjects: Adolescent; Adult; Child; Drug Resistant Epilepsy - diagnostic imaging; Drug Resistant Epilepsy - surgery; Electroencephalography - methods; Epilepsy surgery; Humans; Magnetic Resonance Imaging - methods; Radiofrequency thermoablation; Retrospective Studies; Schizencephaly; Schizencephaly - complications; Schizencephaly - diagnostic imaging; Schizencephaly - surgery; Seizures - surgery; Stereo-encephalography; Stereotaxic Techniques; Tomography, X-Ray Computed; Treatment Outcome; Young Adult; MRI; EEG; RFTA; Schizencephaly; FDG; Epilepsy surgery; Stereo-encephalography; 3D; SEEG; RF; DRE; Radiofrequency thermoablation; PET
• ISSN: 1878-8750; 1878-8769; 1878-8769
• DOI: 10.1016/j.wneu.2023.01.019

Schizencephaly is a congenital cerebral malformation characterized by clefts in the hemispheres of the brain, where variations in semiology often make it difficult to localize epileptogenic focus. Here, we report on a series of patients who underwent stereo-encephalography (SEEG) for epileptogenic focus localization and subsequent SEEG-guided surgical intervention. Four patients (ages 27, 33, 27, 25 years) with a mean seizure history of 16 years (range 8–22 years) were analyzed. Data pertaining to semiology, video encephalography (EEG), magnetic resonance imaging, positron emission tomography, and invasive EEG studies, surgical intervention and post-surgery outcome were collected and analyzed. All seizure onset zones were within the extent of schizencephaly; however, the limbic system (including the hippocampus, amygdala, cingulate gyrus, or insula) was involved in early spreading. Two patients underwent SEEG-guided radiofrequency thermo-ablation (RFTA) in the seizure onset zone, 1 patient underwent lesionectomy via craniotomy, and 1 underwent neither RFTA nor lesionectomy. At 2 years post-surgery, the outcomes were as follows: Engel grade Ia (n = 2), Ib (n = 1), and III (n = 1). This article reports on a precise approach to treating patients with schizencephaly dependent of seizure onset zone and functional cortex mapping. Subsequent SEEG-guided surgical interventions (radiofrequency thermo-ablation and lesionectomy) were shown to reduce seizure frequency, while preserving the neurologic functions in drug-resistant epilepsy patients with schizencephaly.