Combination Resective or Ablative Epilepsy Surgery with Neurostimulation for Complex Epilepsy Networks: A Case Series

Area of Science:

• Neurosurgery
• Epileptology
• Neurology

Background:

• Complex epilepsy with multifocal onset zones overlapping eloquent cortex often requires combined surgical strategies.
• Limited data exist on the outcomes of tandem surgical therapies for refractory epilepsy.
• This study investigates the efficacy of staged combination surgery in select epilepsy patients.

Purpose of the Study:

• To evaluate the outcomes of combined surgical approaches for medically refractory epilepsy.
• To assess seizure frequency reduction following staged combination surgery involving resection/LITT and neuromodulation (RNS/DBS).

Main Methods:

• Retrospective review of 6 adult patients with refractory epilepsy undergoing staged combination surgery (resection/LITT + RNS/DBS) between 2019-2023.
• Inclusion of patients with invasive intracranial monitoring and comprehensive presurgical work-up.
• Primary outcome measured: change in seizure frequency from baseline.

Main Results:

• A mean seizure frequency reduction of 90% was observed at last follow-up.
• All patients achieved at least an 83% reduction in seizures.
• Adverse events included transient visual field deficits and deep vein thrombosis.

Conclusions:

• Staged combination surgery (resection/LITT with RNS/DBS) is a potentially beneficial approach for complex multifocal epilepsy.
• This strategy demonstrates significant seizure reduction in patients with resectable or ablatable lesions.
• Further prospective research is recommended to validate these findings.