Laser interstitial thermal therapy for subependymal giant cell astrocytoma: technical case report

Subependymal giant cell astrocytoma (SEGA) is a rare tumor occurring almost exclusively in patients with tuberous sclerosis complex. Although open resection remains the standard therapy, complication rates remain high. To minimize morbidity, less invasive approaches, such as endoscope-assisted resection, radiosurgery, and chemotherapy with mTOR pathway inhibitors, are also used to treat these lesions. Laser interstitial thermal therapy (LITT) is a relatively new modality that is increasingly used to treat a variety of intracranial lesions. In this report, the authors describe two pediatric cases of SEGA that were treated with LITT. In both patients the lesion responded well to this treatment modality, with tumor shrinkage observed on follow-up MRI. These cases highlight the potential of LITT to serve as a viable minimally invasive therapeutic approach to the management of SEGAs in the pediatric population.

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

Neurosurgery ◽

10.1093/neuros/nyz094 ◽

2019 ◽

Vol 85 (4) ◽

pp. E730-E736 ◽

Cited By ~ 17

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.

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Subependymal giant-cell astrocytoma in children

Journal of Neurosurgery ◽

10.3171/jns.1988.68.6.0880 ◽

1988 ◽

Vol 68 (6) ◽

pp. 880-883 ◽

Cited By ~ 34

Author(s):

Chung W. Chow ◽

Geoffrey L. Klug ◽

Elizabeth A. Lewis

Keyword(s):

Giant Cell ◽

Subependymal Giant Cell Astrocytoma ◽

Low Grade ◽

High Grade ◽

Content Type ◽

Large Numbers ◽

Aggressive Tumor ◽

Fine Print ◽

Giant Cell Astrocytoma

✓ The authors describe five cases of subependymal giant-cell astrocytoma in children in which many clinical, histological, immunohistochemical, and ultrastructural features typical of this tumor were present. However, prominent focal necrosis and mitoses, features usually associated with high-grade tumors, were seen in all cases. Despite the presence of necrosis and mitoses, clinical follow-up studies have revealed a lack of aggressive tumor behavior after surgery alone. The discrepancy between the histological and clinical features in these cases is emphasized so that excessive treatment of a basically low-grade tumor may be avoided. Mast cells were seen in all five cases, often in large numbers.

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Subependymal giant cell astrocytoma: Associated hyperproteinorrhachia causing shunt failures and nonobstructive hydrocephalus - Report of successful treatment with long-term follow-up

Asian Journal of Neurosurgery ◽

10.4103/ajns.ajns_231_16 ◽

2017 ◽

Vol 12 (4) ◽

pp. 746 ◽

Cited By ~ 1

Author(s):

Yosef Laviv ◽

Ekkehard Kasper ◽

Mohammed-AdeebE Sebai ◽

Ning Lin ◽

William Butler

Keyword(s):

Giant Cell ◽

Successful Treatment ◽

Subependymal Giant Cell Astrocytoma ◽

Long Term Follow Up ◽

Giant Cell Astrocytoma

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

Neurosurgical FOCUS ◽

10.3171/2020.1.focus19866 ◽

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.

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Long-term follow-up imaging of subependymal giant cell astrocytoma developing in tuberous sclerosis

Proceedings of the XV Symposium Neuroradiologicum ◽

10.1007/978-3-642-79434-6_145 ◽

1995 ◽

pp. 301-303

Author(s):

H. Shioya ◽

K. Mineura ◽

J. Sasaki ◽

T. Sasajima ◽

M. Kowada ◽

...

Keyword(s):

Tuberous Sclerosis ◽

Giant Cell ◽

Subependymal Giant Cell Astrocytoma ◽

Long Term Follow Up ◽

Giant Cell Astrocytoma

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Early outcomes of stereoelectroencephalography followed by MR-guided laser interstitial thermal therapy: a paradigm for minimally invasive epilepsy surgery

Neurosurgical FOCUS ◽

10.3171/2018.6.focus18209 ◽

2018 ◽

Vol 45 (3) ◽

pp. E8 ◽

Cited By ~ 14

Author(s):

Kelsey Cobourn ◽

Islam Fayed ◽

Robert F. Keating ◽

Chima O. Oluigbo

Keyword(s):

Minimally Invasive ◽

Pediatric Patients ◽

Focal Cortical Dysplasia ◽

Pediatric Population ◽

Outcome Data ◽

Thermal Therapy ◽

Laser Interstitial Thermal Therapy ◽

The Mean ◽

Seizure Foci

OBJECTIVEStereoelectroencephalography (sEEG) and MR-guided laser interstitial thermal therapy (MRgLITT) have both emerged as minimally invasive alternatives to open surgery for the localization and treatment of medically refractory lesional epilepsy. Although some data are available about the use of these procedures individually, reports are almost nonexistent on their use in conjunction. The authors’ aim was to report early outcomes regarding efficacy and safety of sEEG followed by MRgLITT for localization and ablation of seizure foci in the pediatric population with medically refractory lesional epilepsy.METHODSA single-center retrospective review of pediatric patients who underwent sEEG followed by MRgLITT procedures was performed. Demographic, intraoperative, and outcome data were compiled and analyzed.RESULTSFour pediatric patients with 9 total lesions underwent sEEG followed by MRgLITT procedures between January and September 2017. The mean age at surgery was 10.75 (range 2–21) years. Two patients had tuberous sclerosis and 2 had focal cortical dysplasia. Methods of stereotaxy consisted of BrainLab VarioGuide and ROSA robotic guidance, with successful localization of seizure foci in all cases. The sEEG procedure length averaged 153 (range 67–235) minutes, with a mean of 6 (range 4–8) electrodes and 56 (range 18–84) contacts per patient. The MRgLITT procedure length averaged 223 (range 179–252) minutes. The mean duration of monitoring was 6 (range 4–8) days, and the mean total hospital stay was 8 (range 5–11) days. Over a mean follow-up duration of 9.3 (range 5.1–16) months, 3 patients were seizure free (Engel class I, 75%), and 1 patient saw significant improvement in seizure frequency (Engel class II, 25%). There were no complications.CONCLUSIONSThese early data demonstrate that sEEG followed by MRgLITT can be used safely and effectively to localize and ablate epileptogenic foci in a minimally invasive paradigm for treatment of medically refractory lesional epilepsy in pediatric populations. Continued collection of data with extended follow-up is needed.

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