Magnetic resonance–guided laser interstitial thermal therapy for pediatric periventricular nodular heterotopia-related epilepsy

OBJECTIVE Periventricular nodular heterotopia (PVNH) is a result of disrupted neuronal migration from the ventricular system and can be a rare cause of refractory focal epilepsy. The goal of this case series was to describe the treatment of pediatric PVNH-related epilepsy with MR-guided laser interstitial thermal ablation. METHODS Patients treated at a single institution with MR-guided laser interstitial thermal therapy (MRgLITT) for PVNH-related epilepsy were identified. Preoperative and postoperative seizure outcomes and procedural information were evaluated. RESULTS Five children with PVNH treated with MRgLITT were reviewed; 1 child was treated twice. Three patients were female; the median age was 10.9 years. Five of 6 treatments were preceded by stereoelectroencephalography phase II monitoring. Three children experienced unilateral PVNH, and 2 had bilateral seizures. The median number of seizures recorded during phase II monitoring was 2; the median number of ablation targets was 2 (range 1–4). All patients experienced a decrease in seizure frequency; 4 patients (80%) had an Engel class ≤ III at the last follow-up (range I–IV). One child experienced right hemianopia posttreatment. CONCLUSIONS This case series investigation has illustrated a novel, minimally invasive approach for treating pediatric PVNH-related epilepsy. Further study of this technique with comparison with other surgical techniques is warranted.

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Laser Interstitial Thermal Therapy for Epileptogenic Periventricular Nodular Heterotopia

World Neurosurgery ◽

10.1016/j.wneu.2020.03.133 ◽

2020 ◽

Vol 138 ◽

pp. e892-e897 ◽

Cited By ~ 2

Author(s):

Alexander C. Whiting ◽

Justin R. Bingaman ◽

Joshua S. Catapano ◽

Benjamin B. Whiting ◽

Jakub Godzik ◽

...

Keyword(s):

Thermal Therapy ◽

Periventricular Nodular Heterotopia ◽

Laser Interstitial Thermal Therapy ◽

Nodular Heterotopia

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Laser Interstitial Thermal Therapy Case Series: Choosing the Correct Number of Fibers Depending on Lesion Size

Operative Neurosurgery ◽

10.1093/ons/opaa264 ◽

2020 ◽

Vol 20 (1) ◽

pp. 18-23

Author(s):

Kyle P O’Connor ◽

Ali H Palejwala ◽

Camille K Milton ◽

Victor M Lu ◽

Chad A Glenn ◽

...

Keyword(s):

Length Of Stay ◽

Tumor Volume ◽

Treatment Plan ◽

Case Series ◽

Lesion Size ◽

Recurrent Glioblastoma ◽

Thermal Therapy ◽

Recurrent Glioblastoma Multiforme ◽

Laser Interstitial Thermal Therapy ◽

Recurrent Gbm

Abstract BACKGROUND Laser interstitial thermal therapy (LITT) is being used for the treatment of recurrent glioblastoma multiforme (GBM). Lesions can be treated using 1 or multiple LITT fibers depending on the preference of surgeons. Usually, more fibers are needed for coverage of larger tumors. OBJECTIVE To investigate and analyze how tumor size affected the number of LITT fibers used. METHODS This is a retrospective review of patients undergoing treatment of recurrent GBM. Patients were treated with up to 4 LITT fibers for adequate tumor coverage. Patient demographics, tumor characteristics, length of stay, complications, and biopsy results were recorded. RESULTS A total of 43 cases were treated using LITT, and of these cases, 31 consisted of contiguous lesions. We used more fibers to treat larger tumor volumes. On average, for each 5 cc of tumor volume, a fiber was added for proper coverage (P = .554). Complications and length of stay were similar across the groups (P = .378, P = .941). CONCLUSION LITT can be used for the treatment of recurrent GBM. For each 5 cc of tumor volume, a LITT fiber can be added to the treatment plan.

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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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A SARC phase II multicenter trial of imatinib mesylate (IM) in patients with aggressive fibromatosis

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.9515 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 9515-9515 ◽

Cited By ~ 4

Author(s):

R. Chugh ◽

R. G. Maki ◽

D. G. Thomas ◽

D. Reinke ◽

J. K. Wathen ◽

...

Keyword(s):

Phase Ii ◽

Primary Endpoint ◽

Phase Ii Trial ◽

Case Reports ◽

Point Mutations ◽

Case Series ◽

Aggressive Fibromatosis ◽

Median Number ◽

Fresh Tissue ◽

Maximum Change

9515 Background: Aggressive fibromatosis (desmoid tumors, AF) are uncommon, locally aggressive, connective tissue neoplasms. Existing literature on systemic treatment of AF is sparse and consists mostly of case reports and small case-series. Based on previous observation of regression of AF treated with IM and tumoral expression of IM targets, SARC (Sarcoma Alliance for Research through Collaboration) included the treatment of AF onto a multi-institution phase II trial of IM in sarcoma. Here we report early clinical and laboratory results of the AF group. Methods: Eligible patients had histologically proven AF, unresectable or difficult to resect without considerable functional impairment. Patients were treated with IM 300 mg po BID (BSA≥1.5m2). The primary endpoint was complete (CR) or partial response(PR) at two months or stable disease (SD) or better at four months. Tumor DNA was extracted from available formalin fixed paraffin embedded tissue specimens and analyzed via allelic PCR and genomic DNA sequence analysis for specific point mutations in PDGFRα exons 12/14/18, PDGFRβ exons 12/18, KIT exons 9/11/13/17, and bRAF. Results: 51 patients were enrolled from 10/02 to 12/05 at 5 institutions, with 45 patients currently evaluable. The median age is 37 (range 14–67), and median number of prior therapies is 1 (range 0–3). 36 patients (80%) reached the primary endpoint of CR/PR at 2 months or SD or better at 4 months. The median time to treatment failure is 6.8 months (95% C.I. 5.8–17.1). Thus far, the maximum change in the largest dimension of the tumor ranged from a 21% increase to a 45% decrease. In 22 available tumor specimens, deletions within PDGFRαE12 and E18 were noted in 1 and 3 patients, respectively, while a wildtype genotype was found in other regions. Conclusions: IM has activity in AF, the mechanism of which remains unclear. While this is the largest reported phase II trial of AF, further improvement in evaluating clinical efficacy in this disease is clearly necessary. We plan an analysis of the maximum change in largest tumor dimension for each patient, which will be particularly beneficial in AF as responses often occur late. We have not as yet identified a laboratory predictor of clinical benefit. Further investigation of other potential targets in fresh tissue is warranted. [Table: see text]

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Corpus callosotomy via laser interstitial thermal therapy: a case series

Journal of Neurosurgery Pediatrics ◽

10.3171/2018.10.peds18368 ◽

2019 ◽

Vol 23 (3) ◽

pp. 303-307 ◽

Cited By ~ 8

Author(s):

Atilio E. Palma ◽

Robert T. Wicks ◽

Gautam Popli ◽

Daniel E. Couture

Keyword(s):

Surgical Procedure ◽

Case Series ◽

Thermal Therapy ◽

Corpus Callosotomy ◽

Surgical Ablation ◽

Laser Interstitial Thermal Therapy ◽

Generalized Seizures ◽

First Case ◽

Invasive Method ◽

Open Surgical Procedure

Corpus callosotomy has been used as a form of surgical palliation for patients suffering from medically refractory generalized seizures, including drop attacks. Callosotomy has traditionally been described as involving a craniotomy with microdissection. MR-guided laser interstitial thermal therapy (MRg-LITT) has recently been used as a minimally invasive method for performing surgical ablation of epileptogenic foci and corpus callosotomy. The authors present 3 cases in which MRg-LITT was used to perform a corpus callosotomy as part of a staged surgical procedure for a patient with multiple seizure types and in instances when further ablation of residual corpus callosum is necessary after a prior open surgical procedure. To the authors’ knowledge, this is the first case series of corpus callosotomy performed using the MRg-LITT system with a 3.3-year average follow-up. Although MRg-LITT is not expected to replace the traditional corpus callosotomy in all cases, it is a safe, effective, and durable alternative to the traditional open corpus callosotomy, particularly in the setting of a prior craniotomy.

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SURG-05. LASER INTERSTITIAL THERMAL THERAPY FOR MELANOMA BRAIN METASTASIS: A CASE SERIES

Neuro-Oncology Advances ◽

10.1093/noajnl/vdz014.140 ◽

2019 ◽

Vol 1 (Supplement_1) ◽

pp. i31-i31

Author(s):

Ali Palejwala ◽

Kyle O’Connor ◽

Chad Glenn ◽

Michael Sughrue

Keyword(s):

Malignant Melanoma ◽

Adjuvant Therapy ◽

Perioperative Complications ◽

Case Series ◽

Thermal Therapy ◽

Treatment Modalities ◽

Intracranial Metastasis ◽

Laser Interstitial Thermal Therapy ◽

Surgical Data ◽

Tumor Regrowth

Abstract Stereotactic radiosurgery (SRS) and whole brain radiation therapy (WBRT) have been established as non-invasive treatment modalities for intracranial metastasis from malignant melanoma, with SRS emerging as a safe and effective stand along therapy. However, either due to tumor regrowth or radiation necrosis, these radiation modalities can fail. MR-guided laser interstitial thermal therapy (LITT) has emerged as an option for these tumors. Clinical data for five patients at our institution was retrospectively reviewed. These were all the patients that had undergone LITT for intracranial metastatic melanoma after prior treatment failure that included a radiation modality. Demographics, prior treatments, surgical data, perioperative complications, adjuvant treatments, and follow imaging data were gathered. Of the five patients, one patient had received WBRT, three patients had received prior SRS to the area that underwent LITT, and one patient had a prior craniotomy with adjuvant SRS. Two of the tumors were located in the premotor area (frontal lobe), two tumors were located in the motor strip, and one tumor was located in the cerebellum. The average tumor volume was 4.32 cc (range 1.86 - 7.84 cc). Median time of hospital stay was 2 days (with a 2.6 day average). No perioperative complications were encountered. Three of the patients had received adjuvant therapy at our institution; these patients were not delayed in receiving adjuvant therapy. Of these three patients, only one patient had a BRAF mutation detected. Four patients received follow up imaging at our institution, with no patients demonstrating tumor regrowth in the site of LITT. Regrowth of intracranial metastasis of malignant melanoma is a known possibility of traditional radiation therapies. LITT should be considered as a safe, effective option for those that fail these traditional therapies, especially those located in areas difficult to access. The low complication rate allows patients to restart adjuvant therapies.

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Topical Review: Neuronal Migration Disorders, Genetics, and Epileptogenesis

Journal of Child Neurology ◽

10.1177/08830738040190030401 ◽

2004 ◽

Vol 19 (3) ◽

pp. 287-299

Author(s):

Renzo Guerrini ◽

Tiziana Filippi

Keyword(s):

Corpus Callosum ◽

Focal Epilepsy ◽

Infantile Spasms ◽

Periventricular Nodular Heterotopia ◽

Female Patients ◽

Subcortical Band Heterotopia ◽

Nodular Heterotopia ◽

Male Patients ◽

Severe Epilepsy ◽

Band Heterotopia

Several malformation syndromes with abnormal cortical development have been recognized. Specific causative gene defects and characteristic electroclinical patterns have been identified for some. X-linked periventricular nodular heterotopia is mainly seen in female patients and is often associated with focal epilepsy. FLN1 mutations have been reported in all familial cases and in about 25% of sporadic patients. A rare recessive form of periventricular nodular heterotopia owing to ARGEF2 gene mutations has also been reported in children with microcephaly, severe delay, and early-onset seizures. Lissencephaly-pachygyria and subcortical band heterotopia represent a malformative spectrum resulting from mutations of either the LIS1 or the DCX ( XLIS) gene. LIS1 mutations cause a more severe malformation posteriorly. Most children have severe developmental delay and infantile spasms, but milder phenotypes are on record, including posterior subcortical band heterotopia owing to mosaic mutations of LIS1. DCX mutations usually cause anteriorly predominant lissencephaly in male patients and subcortical band heterotopia in female patients. Mutations of the coding region of DCX were found in all reported pedigrees and in about 50% of sporadic female patients with subcortical band heterotopia. Mutations of XLIS have also been found in male patients with anterior subcortical band heterotopia and in female patients with normal brain magnetic resonance imaging. The thickness of the band and the severity of pachygyria correlate with the likelihood of developing severe epilepsy. Autosomal recessive lissencephaly with cerebellar hypoplasia, accompanied by severe delay, hypotonia, and seizures, has been associated with mutations of the reelin ( RELN) gene. X-linked lissencephaly with corpus callosum agenesis and ambiguous genitalia in genotypic males is associated with mutations of the ARX gene. Affected boys have severe delay and infantile spasms with suppression-burst electroencephalograms. Early death is frequent. Carrier female patients can have isolated corpus callosum agenesis. Schizencephaly has a wide anatomoclinical spectrum, including focal epilepsy in most patients. Familial occurrence is rare. Initial reports of heterozygous mutations in the EMX2 gene have not been confirmed. Among several syndromes featuring polymicrogyria, bilateral perisylvian polymicrogyria shows genetic heterogeneity, including linkage to chromosome Xq28 in some pedigrees, autosomal dominant or recessive inheritance in others, and an association with chromosome 22q11.2 deletion in some patients. About 65% of patients have severe epilepsy. Recessive bilateral frontoparietal polymicrogyria has been associated with mutations of the GPR56 gene. ( J Child Neurol 2005;20:287—299).

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Laser Interstitial Thermal Therapy in the Treatment of Thalamic Brain Tumors: A Case Series

Operative Neurosurgery ◽

10.1093/ons/opaa206 ◽

2020 ◽

Author(s):

Roger Murayi ◽

Hamid Borghei-Razavi ◽

Gene H Barnett ◽

Alireza M Mohammadi

Keyword(s):

Brain Tumors ◽

Thermal Damage ◽

Case Series ◽

Outcome Data ◽

Thermal Therapy ◽

Treatment Modalities ◽

Intracerebral Hematoma ◽

Average Hospital ◽

Laser Interstitial Thermal Therapy ◽

Thalamic Tumors

Abstract BACKGROUND Surgical options for patients with thalamic brain tumors are limited. Traditional surgical resection is associated with a high degree of morbidity and mortality. Laser interstitial thermal therapy (LITT) utilizes a stereotactically placed laser probe to induce thermal damage to tumor tissue. LITT provides a surgical cytoreduction option for this challenging patient population. We present our experience treating thalamic brain tumors with LITT. OBJECTIVE To describe our experience and outcomes using LITT on patients with thalamic tumors. METHODS We analyzed 13 consecutive patients treated with LITT for thalamic tumors from 2012 to 2017. Radiographic, clinical characteristics, and outcome data were collected via review of electronic medical records RESULTS Thirteen patients with thalamic tumors were treated with LITT. Most had high-grade gliomas, including glioblastoma (n = 9) and anaplastic astrocytoma (n = 2). The average tumor volume was 12.0 cc and shrank by 42.9% at 3 mo. The average hospital stay was 3.0 d. Median ablation coverage as calculated by thermal damage threshold (TDT) lines was 98% and 95% for yellow (>43°C for >2 min) or blue (>10 min), respectively. Median disease-specific progression-free survival calculated for 8 patients in our cohort was 6.1 mo (range: 1.1-15.1 mo). There were 6 patients with perioperative morbidity and 2 perioperative deaths because of intracerebral hematoma. CONCLUSION LITT is a feasible treatment for patients with thalamic tumors. LITT offers a cytoreduction option in this challenging population. Patient selection is key. Close attention should be paid to lesion size to minimize morbidity. More studies comparing treatment modalities of thalamic tumors need to be performed.

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