Drug-resistant focal epilepsy (DRFE), defined by failure of two antiepileptic drugs, affects 30% of epileptic patients. Epilepsy surgeries are alternative options for this population. Preoperative evaluation is critical to include potential candidates, and to choose the most appropriate procedure to maximize efficacy and simultaneously minimize side effects. Traditional procedures involve open skull surgeries and epileptic focus resection. Alternatively, neuromodulation surgeries use peripheral nerve or deep brain stimulation to reduce the activities of epileptogenic focus. With the advanced improvement of laser-induced thermal therapy (LITT) technique and its utilization in neurosurgery, magnetic resonance-guided LITT (MRgLITT) emerges as a minimal invasive approach for drug-resistant focal epilepsy. In the present review, we first introduce drug-resistant focal epilepsy and summarize the indications, pros and cons of traditional surgical procedures and neuromodulation procedures. And then, focusing on MRgLITT, we thoroughly discuss its history, its technical details, its safety issues, and current evidence on its clinical applications. A case report on MRgLITT is also included to illustrate the preoperational evaluation. We believe that MRgLITT is a promising approach in selected patients with drug-resistant focal epilepsy, although large prospective studies are required to evaluate its efficacy and side effects, as well as to implement a standardized protocol for its application.

中文翻译：

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耐药局灶性癫痫的潜在手术疗法

耐药性局灶性癫痫 (DRFE) 是指两种抗癫痫药物失效，影响 30% 的癫痫患者。癫痫手术是该人群的替代选择。术前评估对于纳入潜在的候选者并选择最合适的手术以最大限度地提高疗效并同时最大限度地减少副作用至关重要。传统手术包括开放性颅骨手术和癫痫病灶切除术。或者，神经调节手术使用周围神经或深部脑刺激来减少致痫灶的活动。随着激光诱导热疗（LITT）技术的进步及其在神经外科中的应用，磁共振引导的LITT（MRgLITT）成为治疗耐药局灶性癫痫的微创方法。在本综述中，我们首先介绍耐药性局灶性癫痫，并总结传统外科手术和神经调节手术的适应症、优缺点。然后，我们重点关注 MRgLITT，深入讨论其历史、技术细节、安全性问题以及其临床应用的当前证据。还包括 MRgLITT 的病例报告来说明术前评估。我们相信，MRgLITT 对于特定的耐药局灶性癫痫患者来说是一种有前途的方法，尽管需要进行大型前瞻性研究来评估其疗效和副作用，并为其应用实施标准化方案。