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

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.

scholarly journals Corpus callosotomy performed with laser interstitial thermal therapy

2019 ◽  
pp. 1-9 ◽  
Author(s):  
Jarod L. Roland ◽  
Syed Hassan A. Akbari ◽  
Afshin Salehi ◽  
Matthew D. Smyth
Keyword(s):  
Refractory Epilepsy ◽  
Effective Means ◽  
Thermal Therapy ◽  
Class Iii ◽  
Corpus Callosotomy ◽  
Invasive Approach ◽  
Laser Interstitial Thermal Therapy ◽  
Less Invasive ◽  
Medically Refractory Epilepsy

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.

scholarly journals Single and staged laser interstitial thermal therapy ablation for cortical tubers causing refractory epilepsy in pediatric patients

2018 ◽  
Vol 45 (3) ◽  
pp. E9 ◽  
Author(s):  
Zulma Tovar-Spinoza ◽  
Robert Ziechmann ◽  
Stephanie Zyck
Keyword(s):  
Laser Ablation ◽  
Minimally Invasive ◽  
Pediatric Patients ◽  
Refractory Epilepsy ◽  
Neuropsychiatric Symptoms ◽  
Thermal Therapy ◽  
Seizure Outcome ◽  
Laser Interstitial Thermal Therapy ◽  
Cortical Tubers ◽  
The Mean

OBJECTIVEMagnetic resonance–guided laser interstitial thermal therapy (MRgLITT) is a novel, minimally invasive treatment for the surgical treatment of epilepsy. In this paper, the authors report on clinical outcomes for a series of pediatric patients with tuberous sclerosis complex (TSC) and medication-refractory epileptogenic cortical tubers.METHODSA retrospective chart review was performed at SUNY Upstate Golisano Children’s Hospital in Syracuse, New York. The authors included all cases involving pediatric patients (< 18 years) who underwent MRgLITT for ablation of epileptogenic cortical tubers between February 2013 and November 2015.RESULTSSeven patients with cortical tubers were treated (4 female and 3 male). The patients’ average age was 6.6 years (range 2–17 years). Two patients had a single procedure, and 5 patients had staged procedures. The mean time between procedures in the staged cases was 6 months. All of the patients had a meaningful reduction in seizure frequency as reported by Engel and ILAE seizure outcome classifications, and most (71.4%) of the patients experienced a reduction in AED burden. Three of the 4 patients who presented with neuropsychiatric symptoms had some improvement in these domains after laser ablation. No perioperative complications were noted. The mean duration of follow-up was 19.3 months (range 4–49 months).CONCLUSIONSLaser ablation represents a minimally invasive alternative to resective epilepsy surgery and is an effective treatment for refractory epilepsy due to cortical tubers.

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

2018 ◽  
Vol 128 (1) ◽  
pp. 277-286 ◽  
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.

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

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.

Anterior Corpus Callosotomy Using Laser Interstitial Thermal Therapy for Refractory Epilepsy

2018 ◽  
Vol 96 (6) ◽  
pp. 406-411 ◽  
Author(s):  
Tyler Ball ◽  
Mayur Sharma ◽  
Andrew C. White ◽  
Joseph S. Neimat
Keyword(s):  
Refractory Epilepsy ◽  
Thermal Therapy ◽  
Corpus Callosotomy ◽  
Laser Interstitial Thermal Therapy

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

2018 ◽  
Vol 45 (3) ◽  
pp. E8 ◽  
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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