Negative MRI and an epileptogenic zone (EZ) adjacent to eloquent areas are two main issues that can be encountered during pre-surgical evaluation for epilepsy surgery. Focal Cortical Dysplasia type II (FCD type II) is the most common aetiology underlying a negative MRI. Pediatric patients who underwent SEEG followed by MRg-LiTT for drug-resistant epilepsy associated with FCD type II at our Centre were included. Pre-surgical videoEEG (vEEG), stereoEEG (sEEG), and MRI were reviewed. Post-procedure clinical outcome (measured by Engel score) and complications rates were evaluated. Three patients underwent 3 MRg-LiTT procedures from January 2022 to June 2022. Epileptogenic zone was previously studied via SEEG in all the patients. All the three patients pre-surgical MRI was deemed negative. Mean age at seizure onset was 47 months (21–96 months), mean age at MRg-LiTT was 12 years (10 years 10 months – 12 years 9 months). Engel class Ia outcome was achieved in patients #2 and #3, Engel class Ib in patient #1. Mean follow-up length was of 17 months (13 months – 20 months). Complications occurred in one patient (patient #2, extradural hematoma). The combined use of SEEG and MRg-LiTT in complex cases can lead to good outcomes both as a rescue therapy after failed surgery, but also as an alternative to open surgery after a successful SEEG-guided Radiofrequency Thermocoagulation (RF-TC). Specific SEEG patterns and a previous good outcome from RF-TC can be predictors of a favourable outcome.

中文翻译：

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FCD II 型 MRI 阴性和癫痫发作区靠近言语区域：在既往手术失败的儿科患者中 SEEG 重新评估后应用 MRg-LiTT

MRI 阴性和邻近功能区域的致癫痫区 (EZ) 是癫痫手术术前评估过程中可能遇到的两个主要问题。 II 型局灶性皮质发育不良（FCD II 型）是 MRI 阴性的最常见病因。包括在我们中心因 FCD II 型相关耐药性癫痫接受 SEEG 治疗并随后接受 MRg-LiTT 治疗的儿童患者。回顾了术前视频脑电图 (vEEG)、立体脑电图 (sEEG) 和 MRI。评估术后临床结果（通过恩格尔评分衡量）和并发症发生率。 2022 年 1 月至 2022 年 6 月，三名患者接受了 3 次 MRg-LiTT 手术。之前通过 SEEG 对所有患者的致癫痫区域进行了研究。所有三名患者的术前 MRI 均被视为阴性。癫痫发作时的平均年龄为 47 个月（21-96 个月），MRg-LiTT 的平均年龄为 12 岁（10 岁 10 个月 – 12 岁 9 个月）。患者 #2 和 #3 实现了 Engel Ia 级结果，患者 #1 实现了 Engel Ib 级结果。平均随访时间为 17 个月（13 个月 – 20 个月）。一名患者（患者#2，硬膜外血肿）出现了并发症。在复杂病例中联合使用 SEEG 和 MRg-LiTT 可以带来良好的结果，既可以作为手术失败后的抢救治疗，也可以作为成功 SEEG 引导射频热凝 (RF-TC) 后开放手术的替代方案。特定的 SEEG 模式和之前 RF-TC 的良好结果可以预测良好的结果。