Surgical targeting of large hypothalamic hamartomas and seizure-freedom following MR-guided laser interstitial thermal therapy

2021 ◽  
Vol 116 ◽  
pp. 107774
Author(s):  
Karim Mithani ◽  
Clemens Neudorfer ◽  
Alexandre Boutet ◽  
Jurgen Germann ◽  
Gavin J.B. Elias ◽  
...  
Keyword(s):  
Thermal Therapy ◽  
Seizure Freedom ◽  
Laser Interstitial Thermal Therapy ◽  
Hypothalamic Hamartomas

scholarly journals Magnetic resonance imaging–guided laser interstitial thermal therapy for previously treated hypothalamic hamartomas

2016 ◽  
Vol 41 (4) ◽  
pp. E8 ◽  
Author(s):  
Anthony M. Burrows ◽  
W. Richard Marsh ◽  
Gregory Worrell ◽  
David A. Woodrum ◽  
Bruce E. Pollock ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Minimally Invasive ◽  
Thermal Therapy ◽  
Seizure Freedom ◽  
Resonance Imaging ◽  
Gelastic Seizures ◽  
Laser Interstitial Thermal Therapy ◽  
Hypothalamic Hamartomas

OBJECTIVE Hypothalamic hamartomas (HHs) are associated with gelastic seizures and the development of medically refractory epilepsy. Magnetic resonance imaging–guided laser interstitial thermal therapy (MRg-LITT) is a minimally invasive ablative treatment that may have applicability for these deep-seated lesions. Here, the authors describe 3 patients with refractory HHs who they treated with MRg-LITT. METHODS An institutional review board–approved prospective database of patients undergoing Visualase MRg-LITT was retrospectively reviewed. Demographic and historical medical data, including seizure and medication histories, previous surgeries, procedural details, and surgical complications, along with radiological interpretation of the HHs, were recorded. The primary outcome was seizure freedom, and secondary outcomes included medication reduction, seizure frequency, operative morbidity, and clinical outcome at the latest follow-up. RESULTS All 3 patients in the multi-institutional database had developed gelastic seizures related to HH at the ages of 7, 7, and 9 years. They presented for further treatment at 25, 28, and 48 years of age, after previous treatments with stereotactic radiosurgery in all cases and partial hamartoma resection in one case. One ablation was complicated by a small tract hemorrhage, which was stable on postoperative imaging. One patient developed hyponatremia and experienced weight gain, which were respectively managed with fluid restriction and counseling. At the most recent follow-up at a mean of 21 months (range 1–32 months), one patient was seizure free while another had meaningful seizure reduction. Medication was reduced in one case. CONCLUSIONS Adults with gelastic seizures despite previous treatments can undergo MRg-LITT with reasonable safety and efficacy. This novel therapy may provide a minimally invasive alternative for primary and recurrent HH as the technique is refined.

scholarly journals Presurgical hyperconnectivity of the ablation volume is associated with seizure-freedom after magnetic resonance-guided laser interstitial thermal therapy

Seizure ◽  
2018 ◽  
Vol 61 ◽  
pp. 89-93 ◽  
Author(s):  
George M. Ibrahim ◽  
Alexander G. Weil ◽  
Shaina Sedighim ◽  
Nathan B. Schoen ◽  
Mirriam Mikhail ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Thermal Therapy ◽  
Seizure Freedom ◽  
Laser Interstitial Thermal Therapy ◽  
Ablation Volume

scholarly journals Open Resection versus Laser Interstitial Thermal Therapy for the Treatment of Pediatric Insular Epilepsy

Neurosurgery ◽  
2019 ◽  
Vol 85 (4) ◽  
pp. E730-E736 ◽  
Author(s):  
Andrew T Hale ◽  
Sonali Sen ◽  
Ali S Haider ◽  
Freedom F Perkins ◽  
Dave F Clarke ◽  
...  
Keyword(s):  
Surgical Resection ◽  
Pediatric Patients ◽  
Average Length ◽  
Insular Cortex ◽  
Thermal Therapy ◽  
Seizure Freedom ◽  
Complication Rates ◽  
Open Resection ◽  
Management Options ◽  
Laser Interstitial Thermal Therapy

AbstractBACKGROUNDVarious studies suggest that the insular cortex may play an underappreciated role in pediatric frontotemporal/parietal epilepsy. Here, we report on the postsurgical outcomes in 26 pediatric patients with confirmed insular involvement by depth electrode monitoring.OBJECTIVETo describe one of the largest series of pediatric patients with medically refractory epilepsy undergoing laser interstitial thermal therapy (LITT) or surgical resection of at least some portion of the insular cortex.METHODSPediatric patients in whom invasive insular sampling confirmed insular involvement and who subsequently underwent a second stage surgery (LITT or open resection) were included. Complications and Engel Class outcomes at least 1 yr postsurgery were compiled as well as pathology results in the open surgical cases.RESULTSThe average age in our cohort was 10.3 yr, 58% were male, and the average length of follow-up was 2.43 ± 0.20 (SEM) yr. A total of 14 patients underwent LITT, whereas 12 patients underwent open resection. Complications in patients undergoing either LITT or open resection were mostly minimal and generally transient. Forty-three percent of patients who underwent LITT were Engel Class I, compared to 50% of patients who underwent open insular resection.CONCLUSIONBoth surgical resection and LITT are valid management options in the treatment of medically refractory insular/opercular epilepsy in children. Although LITT may be a less invasive alternative to craniotomy, further studies are needed to determine its noninferiority in terms of complication rates and seizure freedom, especially in cases of cortical dysplasia that may involve extensive regions of the brain.

scholarly journals Magnetic Resonance Imaging-Guided Focused Laser Interstitial Thermal Therapy for Intracranial Lesions

Neurosurgery ◽  
2013 ◽  
Vol 73 (6) ◽  
pp. 1007-1017 ◽  
Author(s):  
Ammar H. Hawasli ◽  
Swapnil Bagade ◽  
Joshua S. Shimony ◽  
Michelle Miller-Thomas ◽  
Eric C. Leuthardt
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Treatment Option ◽  
Progression Free Survival ◽  
Thermal Therapy ◽  
Seizure Freedom ◽  
Resonance Imaging ◽  
Laser Interstitial Thermal Therapy ◽  
Imaging Characteristics ◽  
Intracranial Lesions

Abstract BACKGROUND: Surgical treatments for deep-seated intracranial lesions have been limited by morbidities associated with resection. Real-time magnetic resonance imaging–guided focused laser interstitial thermal therapy (LITT) offers a minimally invasive surgical treatment option for such lesions. OBJECTIVE: To review treatments and results of patients treated with LITT for intracranial lesions at Washington University School of Medicine. METHODS: In a review of 17 prospectively recruited LITT patients (34–78 years of age; mean, 59 years), we report demographics, treatment details, postoperative imaging characteristics, and peri- and postoperative clinical courses. RESULTS: Targets included 11 gliomas, 5 brain metastases, and 1 epilepsy focus. Lesions were lobar (n = 8), thalamic/basal ganglia (n = 5), insular (n = 3), and corpus callosum (n = 1). Mean target volume was 11.6 cm3, and LITT produced 93% target ablation. Patients with superficial lesions had shorter intensive care unit stays. Ten patients experienced no perioperative morbidities. Morbidities included transient aphasia, hemiparesis, hyponatremia, deep venous thrombosis, and fatal meningitis. Postoperative magnetic resonance imaging showed blood products within the lesion surrounded by new thin uniform rim of contrast enhancement and diffusion restriction. In conjunction with other therapies, LITT targets often showed stable or reduced local disease. Epilepsy focus LITT produced seizure freedom at 8 months. Preliminary overall median progression-free survival and survival from LITT in tumor patients were 7.6 and 10.9 months, respectively. However, this small cohort has not been followed for a sufficient length of time, necessitating future outcomes studies. CONCLUSION: Early peri- and postoperative clinical data demonstrate that LITT is a safe and viable ablative treatment option for intracranial lesions, and may be considered for select patients.

scholarly journals Stereotactic laser interstitial thermal therapy for epilepsy associated with solitary and multiple cerebral cavernous malformations

2020 ◽  
Vol 48 (4) ◽  
pp. E12
Author(s):  
David Satzer ◽  
James X. Tao ◽  
Naoum P. Issa ◽  
Ziyi Chen ◽  
Shasha Wu ◽  
...  
Keyword(s):  
Brain Mri ◽  
Thermal Therapy ◽  
Seizure Freedom ◽  
Lesion Volume ◽  
Complication Rates ◽  
Cavernous Malformations ◽  
Laser Interstitial Thermal Therapy ◽  
Ablation Volume ◽  
Multifocal Lesions

OBJECTIVEThe authors sought to perform a preliminary assessment of the safety and effectiveness of stereotactic laser interstitial thermal therapy (LITT) for patients with cerebral cavernous malformation (CCM)–related epilepsy.METHODSThe authors retrospectively analyzed 6 patients with CCM-related epilepsy who underwent LITT. Pre-, intra-, and postoperative brain MRI studies were used to characterize preoperative CCM volume, ablation volume, and postablation hemosiderin volume. Clinical outcomes were assessed postoperatively during clinic follow-up visits or phone interviews.RESULTSLITT was performed in 7 CCMs in 6 patients. Two patients had familial CCM disease with multifocal lesions. Four treated CCMs were extratemporal, and 3 were in or near the visual pathways. The median follow-up was 25 (range 12–39) months. Five of 6 (83%) patients achieved seizure freedom (Engel I classification), of whom 4 (67%) were Engel IA and 1 was Engel IC after a single seizure on postoperative day 4. The remaining patient had rare seizures (Engel II). One patient had a nondisabling visual field deficit. There were no hemorrhagic complications. All patients were discharged within 24 hours postablation. MRI 3–11 months after ablation demonstrated expected focal necrosis and trace hemosiderin-related T2 hypointensity measuring 9%–44% (median 24%) of the original lesion volume, with significant (p = 0.04) volume reduction.CONCLUSIONSLITT is a minimally invasive option for treating CCM-related epilepsy with seizure outcomes comparable to those achieved with open lesionectomy. The precision of LITT allows for the obliteration of eloquent, deep, small, and multifocal lesions with low complication rates, minimal postoperative discomfort, and short hospital stays. In this study the feasibility and benefits of this method were demonstrated in 2 patients with multifocal lesions.

Staged Magnetic Resonance-Guided Laser Interstitial Thermal Therapy for Hypothalamic Hamartoma: Analysis of Ablation Volumes and Morphological Considerations

Neurosurgery ◽  
2019 ◽  
Vol 86 (6) ◽  
pp. 808-816 ◽  
Author(s):  
Nisha Gadgil ◽  
Sandi Lam ◽  
I-Wen Pan ◽  
Melissa LoPresti ◽  
Kathryn Wagner ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Thermal Therapy ◽  
Invasive Technique ◽  
Seizure Outcome ◽  
Seizure Freedom ◽  
Gelastic Seizures ◽  
Laser Interstitial Thermal Therapy ◽  
Significant Difference ◽  
The Impact

Abstract BACKGROUND Hypothalamic hamartomas (HH) are a challenging pathology that cause gelastic seizures. Magnetic Resonance Imaging-guided Laser Interstitial Thermal Therapy (MRgLITT) offers a safe and effective treatment for HHs via a minimally invasive technique. OBJECTIVE To determine how clinical outcome correlates to residual tumor volume and surgical strategy by analyzing radiographic data and reconstructing volumetric imaging. METHODS Clinical and radiographic information of 58 pediatric patients who underwent MRgLITT for HH with at least 6 mo of follow-up were retrospectively reviewed. MR imaging was volumetrically reconstructed to analyze the impact of hamartoma and ablation volumes on outcome. Primary outcome measure was freedom from gelastic seizures. RESULTS Eighty-one percent of patients were completely free of gelastic seizures at last follow-up; of 22 patients with secondary nongelastic epilepsy, 15 were free of additional seizures. Postoperative complication rate was low. There was no significant difference in gelastic seizure outcome related to pre- or postoperative hamartoma size. Residual hamartoma percentage in those free of gelastic seizures was 43% compared to 71% in those with continued seizures (P = .021). Larger hamartomas required multiple ablations to achieve seizure freedom. CONCLUSION This large series of patients confirms the safety and efficacy of MRgLITT for pediatric HH and describes morphological considerations that predict success. Our data suggest that complete ablation of the lesion is not necessary, and that the focus should be on appropriate disconnection of the epileptogenic network. We have found that a staged approach to hamartoma ablation allows adequate disconnection of the hamartoma while mitigating risk to surrounding structures.

Seizure freedom from recurrent insular low-grade glioma following laser interstitial thermal therapy

2020 ◽  
Vol 36 (5) ◽  
pp. 1055-1059
Author(s):  
TP Easwaran ◽  
A Lion ◽  
AO Vortmeyer ◽  
K Kingery ◽  
McDonald BC ◽  
...  
Keyword(s):  
Low Grade Glioma ◽  
Thermal Therapy ◽  
Seizure Freedom ◽  
Low Grade ◽  
Laser Interstitial Thermal Therapy

Magnetic Resonance Imaging-Guided Laser Interstitial Thermal Therapy for Epilepsy: Systematic Review of Technique, Indications, and Outcomes

Neurosurgery ◽  
2020 ◽  
Vol 86 (4) ◽  
pp. E366-E382 ◽  
Author(s):  
Brett E Youngerman ◽  
Akshay V Save ◽  
Guy M McKhann
Keyword(s):  
Systematic Review ◽  
Side Effects ◽  
Magnetic Resonance ◽  
Thermal Therapy ◽  
Seizure Freedom ◽  
Epileptogenic Zone ◽  
Surgical Morbidity ◽  
Cavernous Malformations ◽  
Laser Interstitial Thermal Therapy ◽  
Advantages And Disadvantages

Abstract BACKGROUND For patients with focal drug-resistant epilepsy (DRE), surgical resection of the epileptogenic zone (EZ) may offer seizure freedom and benefits for quality of life. Yet, concerns remain regarding invasiveness, morbidity, and neurocognitive side effects. Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) has emerged as a less invasive option for stereotactic ablation rather than resection of the EZ. OBJECTIVE To provide an introduction to MRgLITT for epilepsy, including historical development, surgical technique, and role in therapy. METHODS The development of MRgLITT is briefly recounted. A systematic review identified reported techniques and indication-specific outcomes of MRgLITT for DRE in human studies regardless of sample size or follow-up duration. Potential advantages and disadvantages compared to available alternatives for each indication are assessed in an unstructured review. RESULTS Techniques and outcomes are reported for mesial temporal lobe epilepsy, hypothalamic hamartoma, focal cortical dysplasia, nonlesional epilepsy, tuberous sclerosis, periventricular nodular heterotopia, cerebral cavernous malformations, poststroke epilepsy, temporal encephalocele, and corpus callosotomy. CONCLUSION MRgLITT offers access to foci virtually anywhere in the brain with minimal disruption of the overlying cortex and white matter, promising fewer neurological side effects and less surgical morbidity and pain. Compared to other ablative techniques, MRgLITT offers immediate, discrete lesions with real-time monitoring of temperature beyond the fiber tip for damage estimates and off-target injury prevention. Applications of MRgLITT for epilepsy are growing rapidly and, although more evidence of safety and efficacy is needed, there are potential advantages for some patients.

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