• James Mamaril-Davis, Meena Vessell, Tyler Ball, Adriana Palade, Christopher Shafer, Pedro Aguilar-Salinas, Brooks Fowler, Emily Mirro, Joseph Neimat, Vishwanath Sagi, and Robert W Bina.
• College of Medicine, The University of Arizona College of Medicine-Tucson, Tucson, Arizona, USA.
• World Neurosurg. 2022 Nov 1; 167: 195204.e7195-204.e7.

ObjectiveSuper-refractory status epilepticus (SRSE) is a neurologic emergency with high mortality and morbidity. Although medical algorithms typically are effective, when they do fail, options may be limited, and neurosurgical intervention should be considered.MethodsWe report a case of SRSE treated acutely with responsive neurostimulation (RNS) and focal surgical resection after intracranial monitoring. We also conducted a systematic review of the literature for neurosurgical treatment of SRSE (e.g., neurostimulation). Only published manuscripts were considered.ResultsOur patient's seizure semiology consisted of left facial twitching with frequent evolution to bilateral tonic-clonic convulsions. Stereoelectroencephalography and grid monitoring identified multiple seizure foci. The patient underwent right RNS placement with cortical strip leads over the lateral primary motor and premotor cortex as well as simultaneous right superior temporal and frontopolar resection. Status epilepticus resolved 21 days after surgical resection and placement of the RNS. The systematic review revealed 15 case reports describing 17 patients with SRSE who underwent acute neurosurgical intervention. There were 3 patients with SRSE with RNS placement as a single modality, all of whom experienced cessation of SE. Four patients with SRSE received vagus nerve stimulation (3 as a single modality and 1 with combined corpus callosotomy), of whom 1 had SE recurrence at 2weeks. Two patients with SRSE received deep brain stimulation, and the remaining 8 underwent surgical resection; none had recurrence of SE.ConclusionsRNS System placement with or without resection can be a viable treatment option for select patients with SRSE. Early neurosurgical intervention may improve seizure outcomes and reduce complications.Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.

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