Related Experiment Video
Updated: Sep 18, 2025
Anteromesial Temporal Lobectomy for Medically Intractable Temporal Lobe Epilepsy: An Operative Study
Published on: August 15, 2025
Optimized stereoelectroencephalography-guided thermocoagulation versus anterior temporal lobectomy in mesial temporal
Yongzhi Shan1, Jianwei Shi1, Tianren Wang1
1Department of Neurosurgery, Xuanwu Hospital, National Center for Neurological Disorders, National Clinical Research Center for Geriatric Diseases, Capital Medical University, Beijing 100053, China; China International Neuroscience Institute (CHINA-INI), Beijing 100053, China; Beijing Municipal Geriatric Medical Research Center, Beijing 100053, China.
Introduction:
Anterior temporal lobectomy (ATL) is the standard surgical treatment for drug-resistant mesial temporal lobe epilepsy (MTLE); however, it is associated with cognitive decline and visual field deficits. In the current era of personalized medicine and quality-of-life-focused care, minimally invasive surgical strategies are increasingly needed. Optimized stereoelectroencephalography (SEEG)-guided radiofrequency thermocoagulation (RF-TC) is a promising option for preserving cognitive and visual function while providing effective seizure control.
Objectives:
Methods: This assessor-blinded randomized, controlled pilot trial enrolled patients with drug-resistant MTLE at Xuanwu Hospital between August 2019 and October 2022. Participants were randomly allocated (1:1) to the ATL or SEEG-guided RF-TC groups. The primary outcome was the change in cognitive function at the 1-year follow-up, assessed using the Chinese version of the Wechsler Adult Intelligence Scale-IV (WAIS-IV-C). Secondary outcomes included the Wechsler Memory Scale-IV (WMS-IV-C), seizure control (Engel classification), visual fields (Humphrey perimetry), quality of life (QOLIE-89), and adverse events.
Results:
Thirty-eight patients (19 male [50.0 %]; mean [standard deviation] age, 28.3 [7.1] years) were enrolled, with 20 and 18 patients assigned to the ATL and RF-TC groups, respectively. At 1 year, the overall WAIS-IV-C scores did not differ between the ATL and RF-TC groups (P > 0.050). However, patients who underwent dominant-side RF-TC demonstrated superior preservation in the full-scale intelligence quotient (96.91 ± 15.83 vs. 113.44 ± 17.50, P = 0.040), cognitive productivity index (97.36 ± 15.64 vs. 116.89 ± 16.54, P = 0.014), working memory index (97.73 ± 12.89 vs. 115.56 ± 18.80, P = 0.022) and processing speed index (97.91 ± 15.44 vs. 115.00 ± 18.41, P = 0.036) compared to the ATL group. Visual field defects occurred more frequently in the ATL group (15/20, 75.0 %) than in the RF-TC group (3/18, 16.7 %; P < 0.010). The 1-year seizure freedom (Engel I) was comparable (ATL vs. RF-TC, 85.0 % vs. 72.2 %, P = 0.440; Engel IA: 65.0 % vs. 33.3 %, P = 0.103). The RF-TC group experienced fewer adverse events than the ATL group.
Conclusions:
Optimized SEEG-guided RF-TC preserved cognitive and visual function better in dominant-side MTLE than in ATL, with comparable seizure control and quality of life outcomes. Further multicenter studies with larger sample sizes and extended follow-up are needed to validate its efficacy and long-term safety.
Trial Registration:
Clinicaltrials.gov Identifiers: NCT03941613.
