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Panagiotis Kerezoudis, Rohin Singh, Anshit Goyal, Gregory A. Worrell, W. Richard Marsh, Jamie J. Van Gompel, and Kai J. Miller

Approaches We identified and analyzed 5 studies (43 patients) on LITT, 20 , 36–39 2 studies (24 patients) on radiofrequency ablation, 40 , 41 1 study (3 patients) on stereotactic radiosurgery, 42 and 1 study (1 patient) on responsive neurostimulation (RNS). 43 This information is presented in detail in Table 3 . In summary, seizure freedom rates at last follow-up were 54% for LITT, 46% for radiofrequency ablation, 67% for Gamma Knife surgery, and the patient who received RNS achieved an Engel II outcome. Postoperative permanent deficits were extremely rare; only 1

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Panagiotis Kerezoudis, Sanjeet S. Grewal, Matthew Stead, Brian Nils Lundstrom, Jeffrey W. Britton, Cheolsu Shin, Gregory D. Cascino, Benjamin H. Brinkmann, Gregory A. Worrell, and Jamie J. Van Gompel

cortical and subcortical brain regions, including the thalamus, the cerebellum, and the hippocampus, have been selected as neurostimulation targets utilizing either duty cycle 14 or responsive stimulation paradigms. 3 Despite their demonstrated efficacy in randomized controlled trials, currently approved stimulation approaches do not often result in seizure-free outcomes. 3 , 14 Chronic subthreshold cortical stimulation (CSCS) might represent a more effective option. Currently available responsive neurostimulation device detection algorithms 3 use a low spectral

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Sanjeet S. Grewal, Erik H. Middlebrooks, Timothy J. Kaufmann, Matthew Stead, Brian N. Lundstrom, Gregory A. Worrell, Chen Lin, Serhat Baydin, and Jamie J. Van Gompel

F or patients with medically refractory focal epilepsy, surgical interventions include resection, ablation, or neuromodulation. The latter can be performed through vagus nerve stimulation, 31 responsive neurostimulation, 3 chronic subthreshold cortical stimulation, 16 , 22 and deep brain stimulation (DBS). 21 While many sites have been tested for DBS, including the centromedian nucleus of the thalamus (CMT), 21 the most rigorously studied site is the anterior nucleus of the thalamus (ANT). 7 Targeting the ANT has traditionally been accomplished using

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Hirotaka Hasegawa, Jamie J. Van Gompel, W. Richard Marsh, Robert E. Wharen Jr., Richard S. Zimmerman, David B. Burkholder, Brian N. Lundstrom, Jeffrey W. Britton, and Fredric B. Meyer

= no data; PSx = previous surgery; RNS = responsive neurostimulation; SEEG = stereoelectroencephalography. * At the time of VNS placement. † Done at an outside hospital. Establishment of VNS-SSI Among the 16 cases of VNS-SSI, 11 occurred after initial VNS placement and 5 occurred after generator replacement, with 2 of the former and 2 of the latter having undergone the original surgery leading to infection at an outside hospital ( Fig. 1 ). Therefore, the incidence of infection for surgeries performed at our institutions was 1.5% (12

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Sanjeet S. Grewal, Mohammed Ali Alvi, William J. Perkins, Gregory D. Cascino, Jeffrey W. Britton, David B. Burkholder, Elson So, Cheolsu Shin, Richard W. Marsh, Fredric B. Meyer, Gregory A. Worrell, and Jamie J. Van Gompel

be extended based on ECoG findings; however, eloquent areas (speech) are spared ( Fig. 1 ). In the future, adjunctive therapies such as responsive neurostimulation 11 or chronic subthreshold cortical stimulation 14 , 16 could be applied to eloquent areas and could potentially prevent recurrence. Study Limitations Although we have provided the largest review to date on the use of preoperative EEG and intraoperative ECoG and on the outcomes of epilepsy surgery for TLE, our study has limitations. The biggest limitation is the retrospective nature of the study. Scalp