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Nervenheilkunde 2014; 33(05): 370-375
DOI: 10.1055/s-0038-1633408
Epilepsie
Schattauer GmbH

Thermoablation für fokale Epilepsien

Thermoablation in epileptic surgery
F. C. Schmitt
1   Otto-von-Guericke-Universität, Universitätsklinik für Neurologie, Magdeburg
,
F. G. Wörmann
2   Epilepsiezentrum Bethel, Krankenhaus Mara, Bielefeld
,
K. Kopitzki
3   Otto-von-Guericke-Universität, Universitätsklinik für Stereotaktische Neurochirurgie, Magdeburg
,
C. Kluge
1   Otto-von-Guericke-Universität, Universitätsklinik für Neurologie, Magdeburg
,
L. Büntjen
3   Otto-von-Guericke-Universität, Universitätsklinik für Stereotaktische Neurochirurgie, Magdeburg
› Author Affiliations
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Publication History

eingegangen am: 03 February 2014

angenommen am: 04 February 2014

Publication Date:
02 February 2018 (online)

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Zusammenfassung

Die Thermoablation wurde in der Epilepsiechirurgie bereits in den 1950er-Jahren vereinzelt angewandt, dann aber aufgrund der Überlegenheit resektiver Verfahren verlassen. Die Zunahme der Kenntnis über epileptische Netzwerke, über die Propagation und Semiologie von Anfällen sowie über die Pathophysiologie der Epilepsiesyndrome erlaubt inzwischen eine wesentlich differenziertere Hypothesenbildung bezüglich der Lokalisation des epileptischen Netzwerks. Thermoablation bietet im Vergleich zum klassischen resektiven Vorgehen zwei Vorteile. Zum einen ist sie weniger invasiv, zum anderen wiederholt anwendbar. Zudem ist ein nachfolgendes resektives epilepsiechirurgisches Verfahren im Rahmen eines abgestuften Therapiekonzeptes möglich. Die Thermoablation bietet – wie neuere Studien belegen für spezielle Epilepsiesyndrome eine Alternative zur klassischen resektiven Herangehensweise. Im Folgenden wird die aktuelle Datenlage zu diesem Verfahren zusammengefasst. Anhand von zwei Fallbeispielen soll gezeigt werden, dass eine gezielte Patientenauswahl die post-operative Prognose des Verfahrens wesentlich verbessern kann.

Summary

Thermoablation, used in epilepsy surgery since the 50ies, has been abated because of the multiple advantages of resective surgery. However, the increasing knowledge about epileptic networks, about the propagation and semiology of seizures and about the pathophysiology of different epilepsy syndromes enables us nowadays to develop a differentiated hypothesis about the localisation of an epileptic network. In comparison to resective surgery, thermoablation has the intrinsic advantage to be less invasive and repeatedly applicable. Also, a subsequent resective procedure still remains feasible, so that in certain resective surgery candidates a step-by-step approach is possible. As described in recent publications, thermoablation can be used alternatively to resective procedures. In the following, the newest publications will be summarized and two case reports are presented to support the hypothesis that patient selection clearly improves post-operative outcome for this method.

Schlüsselwörter

Radiofrequenz - Stereotaxie - Ablation - periventrikuläre noduläre Heterotopie - fokale kortikale Dysplasie - läsionelle Epilepsie - fokale Epilepsie

Keywords

Radiofrequency - stereotaxy - ablation - periventricular nodular heterotopia - focal cortical dysplasia - lesional epilepsy - focal epilepsy
 

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