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Al-Ramadhani R, Hect JL, Abel TJ. The changing landscape of palliative epilepsy surgery for Lennox Gastaut Syndrome. Front Neurol 2024; 15:1380423. [PMID: 38515452 PMCID: PMC10954786 DOI: 10.3389/fneur.2024.1380423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 02/21/2024] [Indexed: 03/23/2024] Open
Abstract
Lennox Gastaut Syndrome (LGS) is characterized by drug-resistant epilepsy that typically leads to decreased quality of life and deleterious neurodevelopmental comorbidities from medically refractory seizures. In recent years there has been a dramatic increase in the development and availability of novel treatment strategies for Lennox Gastaut Syndrome patient to improve seizure. Recent advances in neuromodulation and minimally invasive magnetic resonance guided laser interstitial thermal therapy (MRgLITT) have paved the way for new treatments strategies including deep brain stimulation (DBS), responsive neurostimulation (RNS), and MRgLITT corpus callosum ablation. These new strategies offer hope for children with drug-resistant generalized epilepsies, but important questions remain about the safety and effectiveness of these new approaches. In this review, we describe the opportunities presented by these new strategies and how each treatment strategy is currently being employed. Next, we will critically assess available evidence for these new approaches compared to traditional palliative epilepsy surgery approaches, such as vagus nerve stimulation (VNS) and open microsurgical corpus callosotomy (CC). Finally, we will describe future directions that would help define which of the available strategies should be employed and when.
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Affiliation(s)
- Ruba Al-Ramadhani
- Department of Pediatrics, Division of Child Neurology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Jasmine L. Hect
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Taylor J. Abel
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, United States
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States
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2
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Phillips HW, Hect JL, Harford E, Pan E, Abel TJ. Comparison of magnetic resonance-guided laser interstitial thermal therapy corpus callosum ablation to open microsurgical corpus callosotomy: A single-center retrospective cohort study. Epilepsia Open 2024; 9:96-105. [PMID: 37766507 PMCID: PMC10839368 DOI: 10.1002/epi4.12835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023] Open
Abstract
OBJECTIVE Corpus callosotomy (CC) is an important treatment for atonic seizures in patients with generalized or multifocal drug-resistant epilepsy (DRE). Traditionally, CC is performed via an open microsurgical approach, but more recently, MR-guided stereotactic laser interstitial thermal therapy (LITT) corpus callosum ablation (CCA) has been developed to leverage the safety and minimally invasive nature of LITT. Given the recent adoption of CCA at select centers, how CCA compares to CC is unknown. We aim to compare the clinical seizure outcomes of CCA and CC after extended follow-up. METHODS We performed a retrospective cohort study to compare the effectiveness and safety of CC to CCA from 1994 to 2022. The primary outcome was a 50% reduction in target seizure. Secondary outcome measures were postoperative length of stay, adverse events, and other effectiveness metrics. Comparative statistics were executed using Stata. Normality for continuous variables was assessed, and parametric statistics were utilized as needed. Frequency was compared with chi-squared or Fischer's exact tests, when applicable. RESULTS Data from 47 operations performed on 36 patients were included in this study, of which 13 (36%) patients underwent 17 CCA. Patients who received CCA had similar rates of meaningful reduction (>50%) of atonic seizures as their CC counterparts (55% vs 70% P = 0.15). Patients undergoing CCA had significantly shorter hospitalizations than those receiving CC (2.5 vs 6.0 days P < 0.001). There was no significant difference in rates of postoperative complications between the groups, although the magnitude of the complication rates was lower in the CCA cohort (12% vs 28%). SIGNIFICANCE This early experience suggests CCA has similar outcomes to traditional CC, albeit with a shorter hospital stay. However, future studies are necessary to investigate the noninferiority between these two approaches. Large multicenter studies are necessary to investigate differences in adverse events and whether these findings generalize across other centers.
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Affiliation(s)
- H. Westley Phillips
- Department of NeurosurgeryStanford University School of MedicinePalo AltoCaliforniaUSA
| | - Jasmine L. Hect
- Department of Neurological SurgeryUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Emily Harford
- Department of Neurological SurgeryUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Evelyn Pan
- Department of Neurological SurgeryUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Taylor J. Abel
- Department of Neurological SurgeryUniversity of PittsburghPittsburghPennsylvaniaUSA
- Department of BioengineeringUniversity of PittsburghPittsburghPennsylvaniaUSA
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Roth J, Bergman L, Weil AG, Brunette-Clement T, Weiner HL, Treiber JM, Shofty B, Cukiert A, Cukiert CM, Tripathi M, Sarat Chandra P, Bollo RJ, Machado HR, Santos MV, Gaillard WD, Oluigbo CO, Ibrahim GM, Jallo GI, Shimony N, O'Neill BR, Budke M, Pérez-Jiménez MÁ, Mangano FT, Iwasaki M, Iijima K, Gonzalez-Martinez J, Kawai K, Ishishita Y, Elbabaa SK, Bello-Espinosa L, Fallah A, Maniquis CAB, Ben-Zvi I, Tisdall M, Panigrahi M, Jayalakshmi S, Blount JP, Dorfmüller G, Bulteau C, Stone SS, Bolton J, Singhal A, Connolly M, Alsowat D, Alotaibi F, Ragheb J, Uliel-Sibony S. Added value of corpus callosotomy following vagus nerve stimulation in children with Lennox-Gastaut syndrome: A multicenter, multinational study. Epilepsia 2023; 64:3205-3212. [PMID: 37823366 DOI: 10.1111/epi.17796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/01/2023] [Accepted: 10/09/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVE Lennox-Gastaut syndrome (LGS) is a severe form of epileptic encephalopathy, presenting during the first years of life, and is very resistant to treatment. Once medical therapy has failed, palliative surgeries such as vagus nerve stimulation (VNS) or corpus callosotomy (CC) are considered. Although CC is more effective than VNS as the primary neurosurgical treatment for LGS-associated drop attacks, there are limited data regarding the added value of CC following VNS. This study aimed to assess the effectiveness of CC preceded by VNS. METHODS This multinational, multicenter retrospective study focuses on LGS children who underwent CC before the age of 18 years, following prior VNS, which failed to achieve satisfactory seizure control. Collected data included epilepsy characteristics, surgical details, epilepsy outcomes, and complications. The primary outcome of this study was a 50% reduction in drop attacks. RESULTS A total of 127 cases were reviewed (80 males). The median age at epilepsy onset was 6 months (interquartile range [IQR] = 3.12-22.75). The median age at VNS surgery was 7 years (IQR = 4-10), and CC was performed at a median age of 11 years (IQR = 8.76-15). The dominant seizure type was drop attacks (tonic or atonic) in 102 patients. Eighty-six patients underwent a single-stage complete CC, and 41 an anterior callosotomy. Ten patients who did not initially have a complete CC underwent a second surgery for completion of CC due to seizure persistence. Overall, there was at least a 50% reduction in drop attacks and other seizures in 83% and 60%, respectively. Permanent morbidity occurred in 1.5%, with no mortality. SIGNIFICANCE CC is vital in seizure control in children with LGS in whom VNS has failed. Surgical risks are low. A complete CC has a tendency toward better effectiveness than anterior CC for some seizure types.
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Affiliation(s)
- Jonathan Roth
- Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Lottem Bergman
- Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Alexander G Weil
- Division of Neurosurgery, Department of Surgery, Sainte-Justine University Hospital Centre and University of Montreal Hospital Centre, Montreal, Quebec, Canada
| | - Tristan Brunette-Clement
- Division of Neurosurgery, Department of Surgery, Sainte-Justine University Hospital Centre and University of Montreal Hospital Centre, Montreal, Quebec, Canada
| | - Howard L Weiner
- Department of Neurosurgery, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
- Division of Pediatric Neurosurgery, Department of Surgery, Texas Children's Hospital, Houston, Texas, USA
| | - Jeffrey M Treiber
- Department of Neurosurgery, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
- Division of Pediatric Neurosurgery, Department of Surgery, Texas Children's Hospital, Houston, Texas, USA
| | - Ben Shofty
- Department of Neurosurgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Arthur Cukiert
- Department of Neurosurgery, Epilepsy Surgery Program, Clinica Cukiert, Sao Paulo, Brazil
| | - Cristine Mella Cukiert
- Department of Neurology and Neurophysiology, Epilepsy Surgery Program, Clinica Cukiert, Sao Paulo, Brazil
| | - Manjari Tripathi
- Center of Excellence for Epilepsy and MEG, AIIMS, New Delhi, India
| | | | - Robert J Bollo
- Division of Pediatric Neurosurgery, University of Utah School of Medicine, Primary Children's Hospital, Salt Lake City, Utah, USA
| | - Hélio Rubens Machado
- Division of Pediatric Neurosurgery, Center for Epilepsy Surgery in Children, Ribeirão Preto Medical School, University of São Paulo, Sao Paulo, Brazil
| | - Marcelo Volpon Santos
- Division of Pediatric Neurosurgery, Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Sao Paulo, Brazil
| | - William D Gaillard
- Department of Neurology, Children's National Medical Center, Washington, District of Columbia, USA
| | - Chima O Oluigbo
- Department of Neurosurgery, Children's National Medical Center, Washington, District of Columbia, USA
| | - George M Ibrahim
- Department of Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - George I Jallo
- Institute for Brain Protection Sciences, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Nir Shimony
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
- Le Bonheur Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, Tennessee, USA
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Brent R O'Neill
- Division of Pediatric Neurosurgery, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Marcelo Budke
- Department of Neurosurgery, Niño Jesus University Children's Hospital, Madrid, Spain
| | | | - Francesco T Mangano
- Division of Pediatric Neurosurgery, Cincinnati Children's Hospital, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Masaki Iwasaki
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Keiya Iijima
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Jorge Gonzalez-Martinez
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Kensuke Kawai
- Department of Neurosurgery, Jichi Medical University, Tochigi, Japan
| | - Yohei Ishishita
- Department of Neurosurgery, Jichi Medical University, Tochigi, Japan
| | - Samer K Elbabaa
- Pediatric Neurosurgery, Leon Pediatric Neuroscience Center of Excellence, Arnold Palmer Hospital for Children, Orlando, Florida, USA
| | - Luis Bello-Espinosa
- Pediatric Neurology and Epilepsy, Leon Pediatric Neuroscience Center of Excellence, Arnold Palmer Hospital for Children, Orlando, Florida, USA
| | - Aria Fallah
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Cassia A B Maniquis
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Ido Ben-Zvi
- Department of Neurosurgery, Great Ormond Street Hospital, London, UK
- Developmental Neurosciences, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Martin Tisdall
- Department of Neurosurgery, Great Ormond Street Hospital, London, UK
- Developmental Neurosciences, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Manas Panigrahi
- Department of Neurosurgery, Krishna Institute of Medical Sciences, Hyderabad, India
| | - Sita Jayalakshmi
- Department of Neurology, Krishna Institute of Medical Sciences, Hyderabad, India
| | - Jeffrey P Blount
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Alabama at Birmingham, Children's Hospital of Alabama, Birmingham, Alabama, USA
| | - Georg Dorfmüller
- Pediatric Neurosurgery Department, Rothschild Foundation Hospital, Paris, France
| | | | - Scellig S Stone
- Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jeffrey Bolton
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ashutosh Singhal
- Division of Pediatric Neurosurgery, Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mary Connolly
- Comprehensive Epilepsy Program, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Daad Alsowat
- Neuroscience Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Faisal Alotaibi
- Neuroscience Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - John Ragheb
- Department of Surgery, Nicklaus Children's Hospital, University of Miami, Leonard M. Miller School of Medicine, Miami, Florida, USA
| | - Shimrit Uliel-Sibony
- Pediatric Neurology Unit, Dana Children's Hospital, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
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Aum DJ, Reynolds RA, McEvoy S, Tomko S, Zempel J, Roland JL, Smyth MD. Surgical outcomes of open and laser interstitial thermal therapy approaches for corpus callosotomy in pediatric epilepsy. Epilepsia 2023; 64:2274-2285. [PMID: 37303192 DOI: 10.1111/epi.17679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/07/2023] [Accepted: 06/08/2023] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Corpus callosotomy (CC) is a palliative surgical intervention for patients with medically refractory epilepsy that has evolved in recent years to include a less-invasive alternative with the use of laser interstitial thermal therapy (LITT). LITT works by heating a stereotactically placed laser fiber to ablative temperatures under real-time magnetic resonance imaging (MRI) thermometry. This study aims to (1) describe the surgical outcomes of CC in a large cohort of children with medically refractory epilepsy, (2) compare anterior and complete CC, and (3) review LITT as a surgical alternative to open craniotomy for CC. METHODS This retrospective cohort study included 103 patients <21 years of age with at least 1 year follow-up at a single institution between 2003 and 2021. Surgical outcomes and the comparative effectiveness of anterior vs complete and open versus LITT surgical approaches were assessed. RESULTS CC was the most common surgical disconnection (65%, n = 67) followed by anterior two-thirds (35%, n = 36), with a portion proceeding to posterior completion (28%, n = 10). The overall surgical complication rate was 6% (n = 6/103). Open craniotomy was the most common approach (87%, n = 90), with LITT used increasingly in recent years (13%, n = 13). Compared to open, LITT had shorter hospital stay (3 days [interquartile range (IQR) 2-5] vs 5 days [IQR 3-7]; p < .05). Modified Engel class I, II, III, and IV outcomes at last follow-up were 19.8% (n = 17/86), 19.8% (n = 17/86), 40.2% (n = 35/86), and 19.8% (n = 17/86). Of the 70 patients with preoperative drop seizures, 75% resolved postoperatively (n = 52/69). SIGNIFICANCE No significant differences in seizure outcome between patients who underwent only anterior CC and complete CC were observed. LITT is a less-invasive surgical alternative to open craniotomy for CC, associated with similar seizure outcomes, lower blood loss, shorter hospital stays, and lower complication rates, but with longer operative times, when compared with the open craniotomy approach.
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Affiliation(s)
- Diane J Aum
- Department of Neurosurgery, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Rebecca A Reynolds
- Division of Pediatric Neurosurgery, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Sean McEvoy
- Department of Neurosurgery, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Stuart Tomko
- Department of Neurology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - John Zempel
- Department of Neurology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Jarod L Roland
- Department of Neurosurgery, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Matthew D Smyth
- Division of Pediatric Neurosurgery, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
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Ordaz JD, Vishnubhotla R, Alfonso A, Budnick H, Wen Q, Radhakrishnan R, Raskin J. Single-Institution Comparative Study of Magnetic Resonance-Guided Laser Interstitial Thermal Therapy and Open Corpus Callosotomy. World Neurosurg 2023; 175:e326-e335. [PMID: 36965660 DOI: 10.1016/j.wneu.2023.03.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 03/19/2023] [Accepted: 03/20/2023] [Indexed: 03/27/2023]
Abstract
OBJECTIVE Open corpus callosotomy (CC) poses a higher risk of perioperative morbidity than does magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) for treatment of drop and generalized seizures without documented superiority. We present a single-institution comparison between open and MRgLITT CC. METHODS A 2-year retrospective review was performed of patients who underwent open and MRgLITT CC (January 2019-January 2021). Demographics, surgical outcome data, hospital costs, and interhemispheric connectivity with diffusion tensor imaging were compared. RESULTS The average age in years was 9.3 and 11.4 for CC (n = 4) and MRgLITT (n = 9), respectively. Preoperative drop seizure frequency was higher in CC (25 vs. 14.5 seizures/day; P = 0.59). At 10 months follow-up, the reduction in drop seizure frequency was better in open CC, but not statistically significant (93.8% vs. 64.3%; P = 0.21). The extent of CC ablation did not correlate with seizure reduction (Pearson coefficient = 0.09). An inverse correlation between interhemispheric connectivity change (diffusion tensor imaging analysis) and drop seizure frequency reduction was noted (Pearson coefficient = -0.97). Total hospital cost was significantly lower in MRgLITT ($67,754 vs. $107,111; P = 0.004), attributed to lower intensive care unit (1.1 vs. 4 days; P= 0.004) and total hospital stay (1.8 vs. 10.5 days; P = 0.0001). Postoperative hydrocephalus was present in 75% of patients in the CC group compared with zero in the MRgLITT group. CONCLUSIONS Our middle-volume single-institution experience shows the safety, efficacy, and cost-effective benefit of MRgLITT compared with the traditional CC with therapeutic equipoise. This study is limited by the number of patients and, hence, further patient enrollment or multicenter study is warranted.
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Affiliation(s)
- Josue D Ordaz
- Department of Neurological Surgery, Indiana University, Indianapolis, Indiana, USA
| | | | - Anthony Alfonso
- School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Hailey Budnick
- Department of Neurological Surgery, Indiana University, Indianapolis, Indiana, USA
| | - Qiuting Wen
- Department of Radiology, Indiana University, Indianapolis, Indiana, USA
| | | | - Jeffrey Raskin
- Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois, USA; Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
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Hale AT, Barkley AS, Blount JP. Corpus Callosotomy Is a Safe and Effective Procedure for Medically Resistant Epilepsy. Adv Tech Stand Neurosurg 2023; 48:355-369. [PMID: 37770691 DOI: 10.1007/978-3-031-36785-4_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
Corpus callosotomy (CC) is an effective surgical treatment for medically resistant generalized or multifocal epilepsy (MRE). The premise of CC extrapolates from the observation that the corpus callosum is the predominant commissural pathway that allows spread and synchroneity of epileptogenic activity between the hemispheres. Candidacy for CC is typically reserved for patients seeking palliative epilepsy treatment with the goal of reducing the frequency of drop attacks, although reduction of other seizure semiologies (absence, complex partial seizures, and tonic-clonic) has been observed. A reduction in morbidity affiliated with evolution of surgical techniques to perform CC has improved the safety profile of the procedure without necessarily sacrificing efficacy.
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Affiliation(s)
- Andrew T Hale
- Division of Pediatric Neurosurgery, Children's of Alabama, Birmingham, AL, USA
| | - Ariana S Barkley
- Division of Pediatric Neurosurgery, Children's of Alabama, Birmingham, AL, USA
| | - Jeffrey P Blount
- Division of Pediatric Neurosurgery, Children's of Alabama, Birmingham, AL, USA.
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Best BJ, Kim I, Lew SM. Magnetic resonance imaging-guided laser interstitial thermal therapy for complete corpus callosotomy: technique and 1-year outcomes. Patient series. JOURNAL OF NEUROSURGERY. CASE LESSONS 2022; 4:CASE22364. [PMID: 36536524 PMCID: PMC9764374 DOI: 10.3171/case22364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 10/27/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Magnetic resonance imaging (MRI)-guided stereotactic laser interstitial thermal therapy (LITT) is a minimally invasive technique that has been described for the treatment of certain forms of epilepsy through partial or complete callosotomy, with few cases describing single-stage complete LITT callosotomy. The authors aimed to demonstrate this technique's feasibility and efficacy through description of the technique and 1-year outcomes in 3 cases of single-stage complete LITT callosotomy in patients with anatomically normal corpa callosa (CCs). OBSERVATIONS The patients were aged 14-27 years and experienced atonic seizures. Completeness of callosotomy was determined from MRI scans obtained >3 months after LITT procedures. The estimated ablations of the CC were 94%, 89%, and 100%, respectively. The second patient had a catheter breach the lateral ventricle, resulting in the lowest estimated percentage of ablation in this series (89%), with minimal atonic seizure reduction. The first patient had significant reduction in atonic seizure frequency, and the third patient had complete resolution of atonic seizures. None of the patients experienced any long-term complications. Intensive care length of stay was 1 night for each patient, and total length of stay was between 2 and 7 nights. Postoperative follow-up was between 14 and 18 months. LESSONS Complete laser callosotomy is achievable and is a safe alternative to microsurgical or endoscopic approaches.
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Affiliation(s)
- Benjamin J. Best
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin; and ,Division of Pediatric Neurosurgery, Children’s Wisconsin, Milwaukee, Wisconsin
| | - Irene Kim
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin; and ,Division of Pediatric Neurosurgery, Children’s Wisconsin, Milwaukee, Wisconsin
| | - Sean M. Lew
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin; and ,Division of Pediatric Neurosurgery, Children’s Wisconsin, Milwaukee, Wisconsin
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Wang YC, Cheng MY, Hung PC, Kuo CY, Hsieh HY, Lin KL, Tu PH, Wu CT, Hsu PW, Wei KC, Chuang CC. Robot-Assisted Radiofrequency Ablation Combined with Thermodynamic Simulation for Epilepsy Reoperations. J Clin Med 2022; 11:jcm11164804. [PMID: 36013044 PMCID: PMC9409811 DOI: 10.3390/jcm11164804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/14/2022] [Accepted: 08/15/2022] [Indexed: 11/30/2022] Open
Abstract
Repeat craniotomies to treat recurrent seizures may be difficult, and minimally invasive radiofrequency ablation is an alternative therapy. On the basis of this procedure, we aimed to develop a more reliable methodology which is helpful for institutions where real-time image monitoring or electrophysiologic guidance during ablation are not available. We used simulation combined with a robot-assisted radiofrequency ablation (S-RARFA) protocol to plan and execute brain epileptic tissue lesioning. Trajectories of electrodes were planned on the robot system, and time-dependent thermodynamics was simulated with radiofrequency parameters. Thermal gradient and margin were displayed on a computer to calculate ablation volume with a mathematic equation. Actual volume was measured on images after the ablation. This small series included one pediatric and two adult patients. The remnant hippocampus, corpus callosum, and irritative zone around arteriovenous malformation nidus were all treated with S-RARFA. The mean error percentage of the volume ablated between preoperative simulation and postoperative measurement was 2.4 ± 0.7%. No complications or newly developed neurologic deficits presented postoperatively, and the patients had little postoperative pain and short hospital stays. In this pilot study, we preliminarily verified the feasibility and safety of this novel protocol. As an alternative to traditional surgeries or real-time monitoring, S-RARFA served as successful seizure reoperation with high accuracy, minimal collateral damage, and good seizure control.
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Affiliation(s)
- Yu-Chi Wang
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Mei-Yun Cheng
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Department of Neurology, Change Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan
| | - Po-Cheng Hung
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Division of Pediatric Neurology, Chang Gung Children’s Hospital, Taoyuan 333, Taiwan
| | - Cheng-Yen Kuo
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Department of Pediatrics, Chang Gung Children’s Hospital, Taoyuan 333, Taiwan
| | - Hsiang-Yao Hsieh
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Department of Neurology, Change Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan
| | - Kuang-Lin Lin
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Division of Pediatric Neurology, Chang Gung Children’s Hospital, Taoyuan 333, Taiwan
| | - Po-Hsun Tu
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Chieh-Tsai Wu
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Peng-Wei Hsu
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Kuo-Chen Wei
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Department of Neurosurgery, New Taipei Municipal Tu Cheng Hospital, Chang Gung Medical Foundation, Taipei 236, Taiwan
| | - Chi-Cheng Chuang
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Correspondence: ; Tel.: +886-3-328-1200 (ext. 2412)
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9
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Stereotactic laser interstitial thermal therapy for the treatment of pediatric drug-resistant epilepsy: indications, techniques, and safety. Childs Nerv Syst 2022; 38:961-970. [PMID: 35274185 DOI: 10.1007/s00381-022-05491-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 03/03/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND MRI-guided laser interstitial thermal therapy (MRgLITT) is a promising alternative to open surgery for treatment of drug-resistant epilepsy, offering significant advantages over traditional approaches for candidate patients, including minimally invasive approach, shorter hospitalization, and decreased patient post-operative discomfort. LITT uses a stereotactically placed fiber optic laser probe to ablate tissue under real-time MR thermometry. METHODS Retrospective chart review of intraoperative and perioperative characteristics was performed for 28 cases of MRgLITT in 25 pediatric patients, ages 4-21 years old, at our institution between 2019 and 2021. MRgLITT ablation of the mesial temporal lobe was performed in 8 cases, extratemporal epileptogenic foci in 9 cases, and for corpus callosotomy in 11 cases. RESULTS At 1 year of follow-up, 53% of all patients experienced improvement in seizure frequency (Engel I or II) (class I: 38%, class II: 15%, class III: 17%, class IV: 31%), including 37% of MTL ablations and 80% extratemporal SOZ ablations. After MRgLITT corpus callosotomy, 71% of patients were free from atonic seizures at most recent follow-up. Median length of hospitalization was 2 days (1-3), including a median ICU stay of 1 day (1-2). CONCLUSION This series demonstrates the safety of MRgLITT as an approach for seizure control in drug-resistant epilepsy. We provide additional evidence that MRgLITT is an effective procedure that is well-tolerated by pediatric patients and is accompanied by an acceptable rate of complications and relatively short hospital stay.
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Rahman R, Ahmed N, Rahman S, Abdulla E, Al-Salihi MM, Rahman MM. Letter: The American Society for Stereotactic and Functional Neurosurgery Position Statement on Laser Interstitial Thermal Therapy for the Treatment of Drug-Resistant Epilepsy. Neurosurgery 2022; 90:e204-e205. [PMID: 35384935 DOI: 10.1227/neu.0000000000001977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 02/23/2022] [Indexed: 11/18/2022] Open
Affiliation(s)
- Raphia Rahman
- Rowan School of Osteopathic Medicine, Stratford, New Jersey, USA
| | - Nazmin Ahmed
- Department of Neurosurgery, Ibrahim Cardiac Hospital and Research Institute (A Centre for Cardiovascular, Neuroscience and Organ Transplant Units), Dhaka, Bangladesh
| | - Sabrina Rahman
- Department of Public Health, Independent University-Bangladesh, Dhaka, Bangladesh
| | - Ebtesam Abdulla
- Department of Neurosurgery, Salmaniya Medical Complex, Manama, Bahrain
| | | | - Md Moshiur Rahman
- Department of Neurosurgery, Holy Family Red Crescent Medical College, Dhaka, Bangladesh
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