Stereoelectroencephalography (SEEG)–Guided Radiofrequency Thermocoagulation (RFTC) of Insular Epileptic Foci

We report, in a cohort of 16 patients presenting with epilepsy arising from the insulo-opercular cortex solely, the outcome following SEEG-guided radiofrequency thermocoagulation (RFTC). Good outcomes (Engel class 1) are reported in 88% at 2 months and 67% at 18 months among the 9 of the 16 cases who had electrodes implanted following parasagittal trajectories. No one had an Engel class 1 outcome at 1 year in the group of 7 patients who had electrodes inserted solely orthogonally. No complications occurred. The benefit-risk ratio of the SEEG-guided RFTC procedure proved to be particularly favorable for patients presenting an epileptogenic focus located in the insula or in the medial aspect of the operculum, especially when using parasagittally, rather than orthogonally, implanted electrodes to coagulate. Therefore, this technique could be used, in selected cases, as the first-line therapeutic option procedure related to insular epilepsy, providing, in many cases, complete control over epileptic disease.