Radiofrequency-thermocoagulation in pediatric epilepsy surgery: A systematic review and pooled analysis of cases

Objective: To conduct a systematic review on radiofrequency thermocoagulation (RF-TC) in pediatric epilepsy surgery. In addition, due to the low number of dedicated pediatric series, to conduct a pooled analysis of cases published in the literature. Methods: We conducted a literature search using PUBMED and EMBASE which produced 432 results. We excluded studies on hypothalamic hamartomas and non-RF-TC procedures such as stereotactic radiosurgery and laser interstitial thermal ablation. Stereotactic RF-TC and SEEG-guided RF-TC procedures were included. Case series and case reports with individualized data were further reviewed and pediatric cases were extracted for pooled analysis. Patient demographics, electroclinical and neuroimaging data, procedure outcomes, responder rates and complications were collected. Our unpublished experience in pediatric SEEG-guided RF-TC was included in the pooled analysis. Results: We identified 33 articles for the literature review, 24 of them were selected for pooled analysis (93 cases). Sixty patients underwent SEEG-guided RF-TC. For adult and pediatric mixed series reported a 67% responder rate and 32% seizure freedom at 1 year. For exclusively pediatric series, 90% responder rate and 71% Seizure freedom. In the pooled analysis, seizure freedom was achieved in 45.2% and responder rate was 74.2% with a mean follow-up was 25.2 months (SD +/- 26.6). Complication rates were low, transient neurological deficits were reported in 18 cases (19.4%) and no deaths were associated with RF-TC. The insula and the dominant frontal lobe were the most frequent targets for ablation. Studies included were highly heterogenous and quality of evidence was low. Significance: There are few pediatric studies evaluating RF-TC. Safety and efficacy in children seem to be similar to that reported in larger adult series, although more studies are needed. Most cases reviewed where extracted from heterogeneous adult and pediatric series. Patients with small, high-risk surgical targets are ideal candidates for this procedure.