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Volume-Based Stereotactic Radiofrequency Thermocoagulation for Drug-Resistant Focal Epilepsy: Preliminary Multicenter

Masaki Iwasaki1, Takahiro Hayashi1, Keiya Iijima1

  • 1Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan.

Operative Neurosurgery (Hagerstown, Md.)
|December 16, 2025
PubMed
Summary

Volume-based stereotactic radiofrequency thermocoagulation (RFTC) is a safe, less invasive epilepsy surgery option. While short-term seizure freedom is promising, long-term outcomes require better patient selection and standardized protocols.

Keywords:
Drug-resistant epilepsyFocal cortical dysplasiaMinimally invasive neurosurgeryRadiofrequency thermocoagulationStereotactic surgery

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Area of Science:

  • Neurosurgery
  • Epileptology
  • Medical Technology

Background:

  • Limited data exists on volume-based stereotactic radiofrequency thermocoagulation (RFTC) clinical outcomes and patient selection.
  • Epilepsy surgery is crucial for drug-resistant focal epilepsy cases.

Purpose of the Study:

  • To evaluate the clinical outcomes of volume-based RFTC for epilepsy in a multicenter Japanese cohort.
  • To identify patient selection criteria for RFTC in epilepsy treatment.

Main Methods:

  • Retrospective analysis of 23 patients with drug-resistant focal epilepsy who underwent volume-based RFTC.
  • Data collection included preoperative and postoperative seizure outcomes, etiology, and surgical details.
  • Follow-up duration averaged 27 months.

Main Results:

  • Seizure freedom was achieved in 59.1% at 1 year and 34.8% at last follow-up.
  • Focal cortical dysplasia was the most common etiology (60.9%).
  • Prior epilepsy surgery correlated with poorer outcomes (P = .02); no other factors showed significant association.

Conclusions:

  • Volume-based RFTC is a safe and effective option for selected epilepsy patients, especially those with deep-seated or eloquent cortex lesions.
  • Short-term seizure control is encouraging, but long-term results necessitate improved patient selection and standardized protocols.