[Efficacy and safety of stereoelectroencephalography-guided 3D radiofrequency thermocoagulation for the treatment of drug-resistant medial temporal lobe epilepsy with hippocampal sclerosis].

Objective: To evaluate the efficacy and safety of stereotactic electroencephalography (SEEG)-guided 3D radiofrequency thermocoagulation (RF-TC) in the treatment of drug-resistant mesial temporal lobe epilepsy with hippocampal sclerosis (mTLE-HS). Methods: This study was a randomized controlled trial. The patients with drug-resistant mTLE-HS recruited from Xuanwu Hospital, Capital Medical University between August 2019 and October 2022 were prospectively enrolled. The patients were randomly assigned to receive either anterior temporal lobectomy (ATL) or RF-TC treatment using a variable block randomization method. All patients were assessed both preoperatively and 1 year postoperatively. The postoperative outcomes in terms of epileptic seizure results, visual field defects, and surgery-related complications were compared between the two groups. Results: A total of 38 patients were included, 19 males and 19 females, with an average age of (28.3±6.9) years. There were 20 cases in the ATL group and 18 cases in the RF-TC group. There was no statistically significant difference in age [(28.5±5.7) vs (28.2±8.1), P=0.848] or gender distribution (7/20 vs 12/18, P=0.103) between the both groups. At the 1-year follow-up post-surgery, there was no statistically significant difference in the proportion of patients achieving Engel Class Ⅰfor epileptic seizure results between the ATL group and the RF-TC group (17/20 vs 13/18, P=0.438). The proportion of patients in the ATL group who developed visual field defects was higher than that in the RF-TC group (15/20 vs 3/18, P<0.010). No severe adverse events were observed in both groups. Conclusion: The epilepsy control efficacy of SEEG-guided 3D RF-TC is comparable to that of traditional surgery, while offering superior outcomes in visual field preservation.