To analysis the safety and efficiency of stereo-electroencephalography (SEEG)-guided multiple electrodes stereo-conformal radiofrequency thermocoagulation in the treatment of drug-resistant insular epilepsy.

Twenty-three patients with drug-resistant insular epilepsy, underwent SEEG-guided multiple electrode stereo-conformal radiofrequency thermocoagulation at Functional Neurosurgery Department of Sanbo Brain Hospital Capital Medical University were retrospective analyzed from February 2016 to January 2020. Standard presurgical evaluation, including semiology, video electro-encephalographic recordings, magnetic resonance imaging, positron emission tomography, and magneto-encephalography, were performed on all the 23 patients, suggesting that the epileptogenic focus located in the insula lobe. According to the diagnosis, electrodes implantation was designed. As the epileptogenic focus inside the insular lobe was verified, the multi-electrode stereo-conformed radiofrequency thermocoagulation treatment was performed. Patients were followed up in hospital, outpatient department or by telephone. Engel classification was used to evaluate the prognosis, and the operative complications were observed.

All the 23 patients were followed up at 3, 6, 12 and 24 months after surgery. By the last follow-up, 12 patients were seizure free (Engel grade Ⅰ), 5 patients had rare seizures (Engel gradeⅡ), 5 patients had seizure reduced by 75% (Engel grade Ⅲ), and 1 patient had a <75% seizure reduction (Engel grade Ⅳ). Two patients developed restorable deep sensory disturbance or motor aphasia after operation, all recovered within 1 month, without permanent neurological dysfunction.

As a minimally invasive, safe and effective treatment for the drug-resistant insular epilepsy patients, SEEG-guided multiple electrode stereo-conformal radiofrequency thermocoagulation can be a complementary treatment for resection surgery.