546 Dose-Response Modeling of Lesion Volume in Pediatric and Adult Stereotactic Electroencephalography Guided Radiofrequency Ablation for Drug-Resistant Epilepsy

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INTRODUCTION: Stereotactic electroencephalography (sEEG) guided radiofrequency ablation (RFA) is an effective treatment for drug-resistant epilepsy (DRE). Despite its growing use, there is no standardized protocol for sEEG-guided RFA energy and duration of ablation, and limited available data. Characterizing the relationship between RFA parameters and resulting lesion volume is vital to precisely control lesion size. METHODS: We reviewed records of 22 patients (12 pediatric, 10 adult) with treated with SEEG-RFA at Children’s Healthcare of Atlanta (2022–2024) and Emory University Hospital (2017–2024). RFA parameters (watts, minutes) and the first post-procedure MRI (T2 for pediatrics, T1 for adults) were analyzed. Lesion volumes were segmented and measured using 3D Slicer. Lesion volume energy was normalized by time-to-MRI by dividing each lesion energy by the square root of time-to-MRI to account for decreasing lesion volumes over time from RFA. RESULTS: There were 70 total lesions identified, 49 for adults (mean age = 35.8 years) and 21 for pediatrics (mean age = 16.25 years). Eight lesions in the adult cohort were excluded due to ambiguous lesion boundaries. Among adult lesions, the median volume was 200.00 mm3 (IQR 300.67) and median adjusted energy delivered was 225.17 J (IQR 98.86). Pediatric lesions had a median volume of 436.0 mm3 (IQR 769.31) and median adjusted energy of 102.50 J (IQR 199.75). CONCLUSIONS: This study reports observed lesion sizes for a given RFA energy, duration, and number of contacts. To our knowledge, it is the largest existing dataset in the neurosurgical literature. Pediatric lesions were generally larger despite lower adjusted energy. However, this observed difference may be confounded by the use of different MRI sequences (T2 for pediatric, T1 for adult), which vary in sensitivity to lesion detection.

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