Corpus callosotomy performed with laser interstitial thermal therapy

OBJECTIVECorpus callosotomy is a palliative procedure that is effective at reducing seizure burden in patients with medically refractory epilepsy. The procedure is traditionally performed via open craniotomy with interhemispheric microdissection to divide the corpus callosum. Concerns for morbidity associated with craniotomy can be a deterrent to patients, families, and referring physicians for surgical treatment of epilepsy. Laser interstitial thermal therapy (LITT) is a less invasive procedure that has been widely adopted in neurosurgery for the treatment of tumors. In this study, the authors investigated LITT as a less invasive approach for corpus callosotomy.METHODSThe authors retrospectively reviewed all patients treated for medically refractory epilepsy by corpus callosotomy, either partial or completion, with LITT. Chart records were analyzed to summarize procedural metrics, length of stay, adverse events, seizure outcomes, and time to follow-up. In select cases, resting-state functional MRI was performed to qualitatively support effective functional disconnection of the cerebral hemispheres.RESULTSTen patients underwent 11 LITT procedures. Five patients received an anterior two-thirds LITT callosotomy as their first procedure. One patient returned after LITT partial callosotomy for completion of callosotomy by LITT. The median hospital stay was 2 days (IQR 1.5–3 days), and the mean follow-up time was 1.0 year (range 1 month to 2.86 years). Functional outcomes are similar to those of open callosotomy, with the greatest effect in patients with a significant component of drop attacks in their seizure semiology. One patient achieved an Engel class II outcome after anterior two-thirds callosotomy resulting in only rare seizures at the 18-month follow-up. Four others were in Engel class III and 5 were Engel class IV. Hemorrhage occurred in 1 patient at the time of removal of the laser fiber, which was placed through the bone flap of a prior open partial callosotomy.CONCLUSIONSLITT appears to be a safe and effective means for performing corpus callosotomy. Additional data are needed to confirm equipoise between open craniotomy and LITT for corpus callosotomy.

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Retrospective analysis of open surgical versus laser interstitial thermal therapy callosotomy in pediatric patients with refractory epilepsy

Journal of Neurosurgery Pediatrics ◽

10.3171/2020.7.peds20167 ◽

2021 ◽

pp. 1-9

Author(s):

James P. Caruso ◽

M. Burhan Janjua ◽

Alison Dolce ◽

Angela V. Price

Keyword(s):

Blood Loss ◽

Retrospective Analysis ◽

Pediatric Patients ◽

Refractory Epilepsy ◽

Thermal Therapy ◽

Efficacy And Safety ◽

Corpus Callosotomy ◽

Laser Interstitial Thermal Therapy ◽

Medically Refractory Epilepsy

OBJECTIVECorpus callosotomy remains an established surgical treatment for certain types of medically refractory epilepsy in pediatric patients. While the traditional surgical approach is often well tolerated, the advent of MR-guided laser interstitial thermal therapy (LITT) provides a new opportunity to ablate the callosal body in a minimally invasive fashion and minimize the risks associated with an open interhemispheric approach. However, the literature is sparse regarding the comparative efficacy and safety profiles of open corpus callosotomy (OCC) and LITT callosotomy. To this end, the authors present a novel retrospective analysis comparing the efficacy and safety of these methods.METHODSPatients who underwent OCC and LITT callosotomy during the period from 2005 to 2018 were included in a single-center retrospective analysis. Patient demographic and procedural variables were collected, including length of stay, procedural blood loss, corticosteroid requirements, postsurgical complications, and postoperative disposition. Pre- and postoperative seizure frequency (according to seizure type) were recorded.RESULTSIn total, 19 patients, who underwent 24 interventions (16 OCC and 8 LITT), were included in the analysis. The mean follow-up durations for the OCC and LITT cohorts were 83.5 months and 12.3 months, respectively. Both groups experienced reduced frequencies of seizure and drop attack frequency postoperatively. Additionally, LITT callosotomy was associated with a significant decrease in estimated blood loss and decreased length of pediatric ICU stay, with a trend of shorter length of hospitalization.CONCLUSIONSLonger-term follow-up and a larger population are required to further delineate the comparative efficacies of LITT callosotomy and OCC for the treatment of pediatric medically refractory epilepsy. However, the authors’ data demonstrate that LITT shows promise as a safe and effective alternative to OCC.

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Efficacy and safety of corpus callosotomy after vagal nerve stimulation in patients with drug-resistant epilepsy

Journal of Neurosurgery ◽

10.3171/2016.10.jns161841 ◽

2018 ◽

Vol 128 (1) ◽

pp. 277-286 ◽

Cited By ~ 3

Author(s):

Jennifer Hong ◽

Atman Desai ◽

Vijay M. Thadani ◽

David W. Roberts

Keyword(s):

Nerve Stimulation ◽

Refractory Epilepsy ◽

Case Series ◽

Vagal Nerve ◽

Vagal Nerve Stimulation ◽

Class Iii ◽

Corpus Callosotomy ◽

Few Data ◽

Medically Refractory Epilepsy

OBJECTIVEVagal nerve stimulation (VNS) and corpus callosotomy (CC) have both been shown to be of benefit in the treatment of medically refractory epilepsy. Recent case series have reviewed the efficacy of VNS in patients who have undergone CC, with encouraging results. There are few data, however, on the use of CC following VNS therapy.METHODSThe records of all patients at the authors' center who underwent CC following VNS between 1998 and 2015 were reviewed. Patient baseline characteristics, operative details, and postoperative outcomes were analyzed.RESULTSTen patients met inclusion criteria. The median follow-up was 72 months, with a minimum follow-up of 12 months (range 12–109 months). The mean time between VNS and CC was 53.7 months. The most common reason for CC was progression of seizures after VNS. Seven patients had anterior CC, and 3 patients returned to the operating room for a completion of the procedure. All patients had a decrease in the rate of falls and drop seizures; 7 patients experienced elimination of drop seizures. Nine patients had an Engel Class III outcome, and 1 patient had a Class IV outcome. There were 3 immediate postoperative complications and 1 delayed complication. One patient developed pneumonia, 1 developed transient mutism, and 1 had persistent weakness in the nondominant foot. One patient presented with a wound infection.CONCLUSIONSThe authors demonstrate that CC can help reduce seizures in patients with medically refractory epilepsy following VNS, particularly with respect to drop attacks.

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Magnetic resonance imaging–guided laser interstitial thermal therapy as treatment for intractable insular epilepsy in children

Journal of Neurosurgery Pediatrics ◽

10.3171/2017.6.peds17158 ◽

2017 ◽

Vol 20 (6) ◽

pp. 575-582 ◽

Cited By ~ 24

Author(s):

M. Scott Perry ◽

David J. Donahue ◽

Saleem I. Malik ◽

Cynthia G. Keator ◽

Angel Hernandez ◽

...

Keyword(s):

Epilepsy Surgery ◽

Medical Center ◽

Surgical Techniques ◽

Intractable Epilepsy ◽

Vascular Supply ◽

Thermal Therapy ◽

Attractive Alternative ◽

Class Iii ◽

Laser Interstitial Thermal Therapy

OBJECTIVESeizure onset within the insula is increasingly recognized as a cause of intractable epilepsy. Surgery within the insula is difficult, with considerable risks, given the rich vascular supply and location near critical cortex. MRI-guided laser interstitial thermal therapy (LiTT) provides an attractive treatment option for insular epilepsy, allowing direct ablation of abnormal tissue while sparing nearby normal cortex. Herein, the authors describe their experience using this technique in a large cohort of children undergoing treatment of intractable localization-related epilepsy of insular onset.METHODSThe combined epilepsy surgery database of Cook Children’s Medical Center and Dell Children’s Hospital was queried for all cases of insular onset epilepsy treated with LiTT. Patients without at least 6 months of follow-up data and cases preoperatively designated as palliative were excluded. Patient demographics, presurgical evaluation, surgical plan, and outcome were collected from patient charts and described.RESULTSTwenty patients (mean age 12.8 years, range 6.1–18.6 years) underwent a total of 24 LiTT procedures; 70% of these patients had normal findings on MRI. Patients underwent a mean follow-up of 20.4 months after their last surgery (range 7–39 months), with 10 (50%) in Engel Class I, 1 (5%) in Engel Class II, 5 (25%) in Engel Class III, and 4 (20%) in Engel Class IV at last follow-up. Patients were discharged within 24 hours of the procedure in 15 (63%) cases, in 48 hours in 6 (24%) cases, and in more than 48 hours in the remaining cases. Adverse functional effects were experienced following 7 (29%) of the procedures: mild hemiparesis after 6 procedures (all patients experienced complete resolution or had minimal residual dysfunction by 6 months), and expressive language dysfunction after 1 procedure (resolved by 3 months).CONCLUSIONSTo their knowledge, the authors present the largest cohort of pediatric patients undergoing insular surgery for treatment of intractable epilepsy. The patient outcomes suggest that LiTT can successfully treat intractable seizures originating within the insula and offers an attractive alternative to open resection. This is the first description of LiTT applied to insular epilepsy and represents one of only a few series describing the use of LiTT in children. The results indicate that seizure reduction after LiTT compares favorably to that after conventional open surgical techniques.

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Erratum to “A Primer on Magnetic Resonance-Guided Laser Interstitial Thermal Therapy for Medically Refractory Epilepsy” by Lee EJ, et al. (J Korean Neurosurg Soc 62 : 353-360, 2019)

Journal of Korean Neurosurgical Society ◽

10.3340/jkns.2019.0105.e1 ◽

2019 ◽

Vol 62 (4) ◽

pp. 492-492

Keyword(s):

Magnetic Resonance ◽

Refractory Epilepsy ◽

Thermal Therapy ◽

Laser Interstitial Thermal Therapy ◽

Medically Refractory Epilepsy

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Erratum to “A Primer on Magnetic Resonance-Guided Laser Interstitial Thermal Therapy for Medically Refractory Epilepsy” by Lee EJ, et al. (J Korean Neurosurg Soc 62 : 353-360, 2019)

Journal of Korean Neurosurgical Society ◽

10.3340/jkns.2017.2019.0105.e1 ◽

2019 ◽

Vol 62 (4) ◽

pp. 492-492

Keyword(s):

Magnetic Resonance ◽

Refractory Epilepsy ◽

Thermal Therapy ◽

Laser Interstitial Thermal Therapy ◽

Medically Refractory Epilepsy

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Management of patients with medically intractable epilepsy and anterior temporal lobe encephaloceles

Journal of Neurosurgery ◽

10.3171/2021.3.jns21133 ◽

2021 ◽

pp. 1-8

Author(s):

Mani Ratnesh S. Sandhu ◽

Mauricio Mandel ◽

Hari McGrath ◽

Layton Lamsam ◽

Pue Farooque ◽

...

Keyword(s):

Temporal Lobe ◽

Refractory Epilepsy ◽

Preoperative Evaluation ◽

Intractable Epilepsy ◽

Class Iii ◽

Single Institution ◽

Scalp Eeg ◽

Surgical Data ◽

Medically Refractory Epilepsy

OBJECTIVE Temporal lobe encephaloceles (TLENs) are a significant cause of medically refractory epilepsy, but there is little consensus regarding their workup and treatment. This study characterizes these lesions and their role in seizures and aims to standardize preoperative evaluation and surgical management. METHODS Patients with TLEN who had undergone resective epilepsy surgery from December 2015 to August 2020 at a single institution were included in the study. Medical records were reviewed for each patient to collect relevant seizure workup information including demographics, radiological findings, surgical data, and neuropsychological evaluation. RESULTS For patients who presented to the authors’ program with suspected medically intractable temporal lobe epilepsy (219 patients), TLEN was considered to be the epileptogenic focus in 5.5%. Ten patients with TLEN had undergone resection and were included in this study. Concordance between ictal scalp electroencephalography (EEG) lateralization and TLEN was found in 9/10 patients (90%), and 4/10 patients (40%) had signs suggestive of idiopathic intracranial hypertension (IIH). Surgical outcome was reported in patients with at least 12 months of follow-up (9/10). Patients with scalp EEG findings concordant with the TLEN side had a good outcome (Engel class I: 7 patients, class II: 1 patient). One patient with discordant EEG findings had a bad outcome (Engel class III). No significant neuropsychological deficits were observed after the surgery. CONCLUSIONS TLENs are epileptogenic lesions that should be screened for in patients with medically refractory epilepsy who have signs of IIH and no other lesions on MRI. Restricted resection is safe and effective in patients with scalp EEG findings concordant with TLEN.

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Intracranial EEG and laser interstitial thermal therapy in MRI-negative insular and/or cingulate epilepsy: case series

Journal of Neurosurgery ◽

10.3171/2020.7.jns201912 ◽

2020 ◽

pp. 1-9

Author(s):

Elakkat D. Gireesh ◽

Kihyeong Lee ◽

Holly Skinner ◽

Joohee Seo ◽

Po-Ching Chen ◽

...

Keyword(s):

Surgical Management ◽

Refractory Epilepsy ◽

Case Series ◽

Inpatient Rehabilitation ◽

Thermal Therapy ◽

Class I ◽

Neurological Deficits ◽

Laser Interstitial Thermal Therapy ◽

Right Hand

OBJECTIVEThe goal of this study was to assess the success rate and complications of stereo-electroencephalography (sEEG) and laser interstitial thermal therapy (LITT) in the treatment of nonlesional refractory epilepsy in cingulate and insular cortex.METHODSThe authors retrospectively analyzed the treatment response in 9 successive patients who underwent insular or cingulate LITT for nonlesional refractory epilepsy at their center between 2011 and 2019. Localization of seizures was based on inpatient video-EEG monitoring, neuropsychological testing, 3-T MRI, PET scan, magnetoencephalography scan, and/or ictal SPECT scan. Eight patients underwent sEEG, and 1 patient had implantation of both sEEG electrodes and subdural grids for localization of epileptogenic zones. LITT was performed in 5 insular cases (4 left and 1 right) and 3 cingulate cases (all left-sided). One patient also underwent both insular and cingulate LITT on the left side. All of the patients who underwent insular LITT as well as 2 of the 3 who underwent cingulate LITT were right-hand dominant. The patient who underwent insular plus cingulate LITT was also right-hand dominant.RESULTSFollowing LITT, 67% of the patients were seizure free (Engel class I) at follow-up (mean 1.35 years, range 0.6–2.8 years). All patients responded favorably to treatment (Engel class I–III). Two patients developed small intracranial hemorrhages during the sEEG implantation that did not require surgical management. One patient developed a large intracranial hemorrhage during an insular LITT procedure that did require surgical management. That patient experienced aphasia, incoordination, and hemiparesis, which resolved with inpatient rehabilitation. No permanent neurological deficits were noted in any of the patients at last follow-up. Neuropsychological status was stable in this cohort before and after LITT.CONCLUSIONSsEEG can be safely used to localize seizures originating from insular and cingulate cortex. LITT can successfully treat seizures arising from these deep-seated structures. The insula and cingulum should be evaluated more frequently for seizure onset zones.

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