Speakers

Focused ultrasound - from lesioning to neuromodulation
1110 10:00-10:10
Functional Neurosurgery & Epilepsy/304A
Introduction Drug-resistant epilepsy (DRE) is a clinical dilemma and needs surgical intervention . Besides the definite surgeries such as lobectomy, lesionectomy, and disconnection, neuromodulation is an alternative treatment of choice that inhibits the epileptogenesis and/or disrupts epileptogenic network. Methods The candidates underwent comprehensive pre-surgical evaluation and applied stereo-electroencephalography (SEEG) to determine the seizure onset zone, irritative zone, symptomatics zone, and related epileptogenic network. Once we can define the earliest seizure onset zone, the sonication via NaviFUS system would be prepared for modulating the epileptogenic lesions. After skull attenuation simulating and treatment planning via thin-cut CT and MRI, the NaviFUS system delivered the neuromodulating dosage (ISPTA 2.8 W/cm2, duty: 30%, modulating duration: 10 minutes) to the lesions under guidance of navigation system. Dose-limiting toxicity and adverse event were recorded for safety issue. The encephalography (EEG) recordings were presented for neuromodulating effect for three days. The patients underwent the high-resoluation MRI 14 days after sonication. Results Two patients met the criterial and were enrolled in clinical trial. Both 2 patients felt warm sensation on the contact surface of scalp when sonication. The short-term EEG recording showed that all epileptic indexes disappeared in patient 1 within 12 hours after FUS treatment. In patient 2, the seizure occurred in 1 hours. However, other epileptic indexes reduced within 12 hours after FUS treatment. The followed MRI showed no any edema or lesion. During thirteen follow-up days, there were no reported unanticipated adverse events or symptomatic intracranial hemorrhages. Conclusion FUS for DRE patients is a safe tool when we modulate the epileptogenic foci. FUS seems to be effective to suppress the epileptogenic activities for a period of time (less than 12 hours).

Stereoelectroencephalography and SEEG-guided radiofrequency RF ablation
1110 10:50-11:00
Functional Neurosurgery & Epilepsy/304A
SEEG served as a good tool to explore the epitogenic zone (EZ) deep in the brain. Since 2013, we have performed SEEG to localize the EZ in 120+ patients with drug resistant epilepsy (DRE). Once the EZ was identified, the definite resection was usually applied to ensure the best seizure outcome. However, in patient with hypothalamus harmatoma and periventricular nodular heterotopia (PNH), these lesions were deep and difficult to approach. Or, in some cases, the EZs are vague and difficult to define the extent of EZ. The RF ablation would be the best alternative treatment for either curative attempt or trial to suspicious epileptogenic lesion for further ultimate surgical resection. There are two goal of SEEG-guided RF ablation: one is for cure, and another one is for trial. Despite of the high incidence of recurrence, the RF ablation can be performed repeatedly with minimal invasion. Therefore, the SEEG-guided RFA play an important role in identified the EZ, and ensure the better surgical outcome for DRE.