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Obaid S, Guillemette A, Lapalme-Remis S, Yang JYM, Weil AG, Bouthillier A. Laser interstitial thermal therapy of a single nodule in a complex epileptic network with multiple periventricular nodular heterotopias. NEUROSURGICAL FOCUS: VIDEO 2024; 11:V15. [PMID: 38957415 PMCID: PMC11216539 DOI: 10.3171/2024.4.focvid2417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 04/12/2024] [Indexed: 07/04/2024]
Abstract
Surgical management of drug-resistant epilepsy (DRE) in patients with multiple periventricular nodular heterotopias (PVNHs) is challenging. Identifying the location of seizure onset within these complex epileptic networks is difficult, and open resection carries risks of injury to surrounding functional white matter tracts such as optic radiations (ORs). The authors demonstrate tractography-assisted laser ablation of a single nodule in a patient with DRE and multiple PVNHs. Following surgery, visual fields were intact, highlighting the benefits of OR tractographic reconstruction. At 12 months postoperatively, the patient remained seizure free, suggesting the potential efficacy of targeting a single heterotopia within complex networks in well-selected cases. The video can be found here: https://stream.cadmore.media/r10.3171/2024.4.FOCVID2417.
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Affiliation(s)
- Sami Obaid
- University of Montreal Hospital Center Research Center (CRCHUM), Montréal, Québec, Canada
- Division of Neurosurgery, University of Montreal Hospital Center (CHUM), Montréal, Québec, Canada
- Departments of Surgery and
| | - Albert Guillemette
- University of Montreal Hospital Center Research Center (CRCHUM), Montréal, Québec, Canada
- Division of Neurosurgery, University of Montreal Hospital Center (CHUM), Montréal, Québec, Canada
| | - Samuel Lapalme-Remis
- Neuroscience, University of Montreal, Montréal, Québec, Canada
- Division of Neurology, University of Montreal Hospital Center (CHUM), Montréal, Québec, Canada
| | - Joseph Yuan-Mou Yang
- Neuroscience Advanced Clinical Imaging Service (NACIS), Department of Neurosurgery, The Royal Children’s Hospital, Melbourne, Victoria, Australia; and
| | - Alexander G. Weil
- Division of Neurosurgery, University of Montreal Hospital Center (CHUM), Montréal, Québec, Canada
- Division of Pediatric Neurosurgery, Department of Surgery, Sainte Justine Hospital, Montréal, Québec, Canada
| | - Alain Bouthillier
- Division of Neurosurgery, University of Montreal Hospital Center (CHUM), Montréal, Québec, Canada
- Departments of Surgery and
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Zhang J, Liu J, Huang Y, Yan L, Xu S, Zhang G, Pei L, Yu H, Zhu X, Han X. Current role of magnetic resonance imaging on assessing and monitoring the efficacy of phototherapy. Magn Reson Imaging 2024; 110:149-160. [PMID: 38621553 DOI: 10.1016/j.mri.2024.04.012] [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: 03/08/2024] [Revised: 04/06/2024] [Accepted: 04/10/2024] [Indexed: 04/17/2024]
Abstract
Phototherapy, also known as photobiological therapy, is a non-invasive and highly effective physical treatment method. Its broad use in clinics has led to significant therapeutic results. Phototherapy parameters, such as intensity, wavelength, and duration, can be adjusted to create specific therapeutic effects for various medical conditions. Meanwhile, Magnetic Resonance Imaging (MRI), with its diverse imaging sequences and excellent soft-tissue contrast, provides a valuable tool to understand the therapeutic effects and mechanisms of phototherapy. This review explores the clinical applications of commonly used phototherapy techniques, gives a brief overview of how phototherapy impacts different diseases, and examines MRI's role in various phototherapeutic scenarios. We argue that MRI is crucial for precise targeting, treatment monitoring, and prognosis assessment in phototherapy. Future research and applications will focus on personalized diagnosis and monitoring of phototherapy, expanding its applications in treatment and exploring multimodal imaging technology to enhance diagnostic and therapeutic precision and effectiveness.
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Affiliation(s)
- Jiangong Zhang
- Department of Nuclear Medicine, The First people's Hospital of Yancheng, The Yancheng Clinical College of Xuzhou Medical University, Yancheng, PR China
| | - Jiahuan Liu
- Department of Radiology, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, PR China
| | - Yang Huang
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, PR China
| | - Linlin Yan
- Department of Radiology, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, PR China
| | - Shufeng Xu
- Department of Radiology, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, PR China
| | - Guozheng Zhang
- Department of Radiology, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, PR China
| | - Lei Pei
- Department of Radiology, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, PR China
| | - Huachen Yu
- Department of Orthopedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, PR China
| | - Xisong Zhu
- Department of Radiology, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, PR China
| | - Xiaowei Han
- Department of Radiology, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, PR China.
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Dulamea AO, Lupescu IC. Cerebral cavernous malformations - An overview on genetics, clinical aspects and therapeutic strategies. J Neurol Sci 2024; 461:123044. [PMID: 38749279 DOI: 10.1016/j.jns.2024.123044] [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: 10/16/2023] [Revised: 04/28/2024] [Accepted: 05/08/2024] [Indexed: 06/13/2024]
Abstract
Cerebral cavernous malformations (CCMs) are abnormally packed blood vessels lined with endothelial cells, that do not exhibit intervening tight junctions, lack muscular and elastic layers and are usually surrounded by hemosiderin and gliosis. CCMs may be sporadic or familial autosomal dominant (FCCMs) caused by loss of function mutations in CCM1 (KRIT1), CCM2 (MGC4607), and CCM3 (PDCD10) genes. In the FCCMs, patients have multiple CCMs, different family members are affected, and developmental venous anomalies are absent. CCMs may be asymptomatic or may manifest with focal neurological deficits with or without associated hemorrhage andseizures. Recent studies identify a digenic "triple-hit" mechanism involving the aquisition of three distinct genetic mutations that culminate in phosphatidylinositol-3-kinase (PIK3CA) gain of function, as the basis for rapidly growing and clinically symptomatic CCMs. The pathophysiology of CCMs involves signaling aberrations in the neurovascular unit, including proliferative dysangiogenesis, blood-brain barrier hyperpermeability, inflammation and immune mediated processes, anticoagulant vascular domain, and gut microbiome-driven mechanisms. Clinical trials are investigating potential therapies, magnetic resonance imaging and plasma biomarkers for hemorrhage and CCMs-related epilepsy, as well as different techniques of neuronavigation and neurosonology to guide surgery in order to minimize post-operatory morbidity and mortality. This review addresses the recent data about the natural history, genetics, neuroimaging and therapeutic approaches for CCMs.
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Affiliation(s)
- Adriana Octaviana Dulamea
- Carol Davila University of Medicine and Pharmacy, 37 Dionisie Lupu Street, 020021 Bucharest, Romania; Fundeni Clinical Institute, Department of Neurology, 258 Fundeni Street, 022328 Bucharest, Romania.
| | - Ioan Cristian Lupescu
- Carol Davila University of Medicine and Pharmacy, 37 Dionisie Lupu Street, 020021 Bucharest, Romania; Fundeni Clinical Institute, Department of Neurology, 258 Fundeni Street, 022328 Bucharest, Romania
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Bosisio L, Cognolato E, Nobile G, Mancardi MM, Nobili L, Pacetti M, Piatelli G, Giacomini T, Calevo MG, Fragola M, Venanzi MS, Consales A. Surgical treatment of cavernous malformation-related epilepsy in children: case series, systematic review, and meta-analysis. Neurosurg Rev 2024; 47:251. [PMID: 38819574 DOI: 10.1007/s10143-024-02491-0] [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: 03/07/2024] [Revised: 05/07/2024] [Accepted: 05/25/2024] [Indexed: 06/01/2024]
Abstract
OBJECTIVE Cerebral cavernous malformations (CCMs) are cerebral vascular lesions that occasionally occur with seizures. We present a retrospective case series from IRCCS Gaslini Children's Hospital, a systematic review, and meta-analysis of the literature with the goal of elucidating the post-surgery seizure outcome in children with CCMs. METHODS a retrospective review of children with cavernous malformation related epilepsy who underwent surgery at Gaslini Children's Hospital from 2005 to 2022 was conducted. We also conducted a comprehensive search on PubMed/MEDLINE and Scopus databases from January 1989 to August 2022. Inclusion criteria were: presence of CCMs-related epilepsy, in under 18 years old subjects with a clear lesion site. Presence of post-surgery seizure outcome and follow-up ≥ 12 months. RESULTS we identified 30 manuscripts and 223 patients with CCMs-related epilepsy, including 17 patients reported in our series. We identified 85.7% Engel class I subjects. The risk of expected neurological deficits was 3.7%; that of unexpected neurological deficits 2.8%. We found no statistically significant correlations between Engel class and the following factors: site of lesion, type of seizure, drug resistance, duration of disease, type of surgery, presence of multiple CCMs. However, we found some interesting trends: longer disease duration and drug resistance seem to be more frequent in subjects in Engel class II, III and IV; multiple cavernomas would not seem to influence seizure outcome. CONCLUSIONS epilepsy surgery in children with CCMs is a safe and successful treatment option. Further studies are necessary to define the impact of clinical features on seizure prognosis.
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Affiliation(s)
- Luca Bosisio
- Child Neuropsychiatry, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health Department of Neuroscience (DINOGMI), IRCCS Istituto Giannina Gaslini, University of Genoa, Genoa, Italy.
| | - Erica Cognolato
- Child Neuropsychiatry, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health Department of Neuroscience (DINOGMI), IRCCS Istituto Giannina Gaslini, University of Genoa, Genoa, Italy
| | - Giulia Nobile
- Child Neuropsychiatry Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | | | - Lino Nobili
- Child Neuropsychiatry, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health Department of Neuroscience (DINOGMI), IRCCS Istituto Giannina Gaslini, University of Genoa, Genoa, Italy
- Child Neuropsychiatry Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Mattia Pacetti
- Pediatric Neurosurgery Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Gianluca Piatelli
- Pediatric Neurosurgery Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Thea Giacomini
- Child Neuropsychiatry Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Maria Grazia Calevo
- Epidemiology and Biostatistics Unit, Scientific Direction, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Martina Fragola
- Epidemiology and Biostatistics Unit, Scientific Direction, IRCCS Istituto Giannina Gaslini, Genoa, Italy
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Polyanskaya MV, Demushkina AA, Vasilyev IG, Kostylev FA, Kurbanova FA, Zavadenko NN, Alikhanov AA. [Neuroradiological and pathohistological markers of the main epileptogenic substrates in children. Other cerebral disorders]. Zh Nevrol Psikhiatr Im S S Korsakova 2024; 124:16-23. [PMID: 38261280 DOI: 10.17116/jnevro202412401116] [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] [Indexed: 01/24/2024]
Abstract
High-resolution MRI is an important tool in the diagnosis of structural epilepsy |in determining the seizure initiation zones, identification of the mechanisms of epileptogenesis in predicting outcomes and preventing postoperative complications in patients. In this article we have tried to demonstrate the neuroradiological and pathohistological characteristics of the main epileptogenic substrates in children using modern classification. The second part of the article is devoted to the spectrum of epileptogenic cerebral disorders, in addition to cortical malformations.
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Affiliation(s)
- M V Polyanskaya
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - A A Demushkina
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - I G Vasilyev
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - F A Kostylev
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - F A Kurbanova
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - N N Zavadenko
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - A A Alikhanov
- Pirogov Russian National Research Medical University, Moscow, Russia
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Niu H, Li K, Liang X, Kong D, Li Z, Sun F, Liu X, Xu Z, Wei X, Lan S, Lu C. MR-guided laser interstitial thermal therapy for drug-resistant lesional epilepsy: a single-center experience. Chin Neurosurg J 2023; 9:26. [PMID: 37723550 PMCID: PMC10506236 DOI: 10.1186/s41016-023-00335-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 07/10/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND To describe and report the efficacy and safety of MR-guided laser interstitial thermal therapy (MRgLITT) in the treatment of drug-resistant epilepsy. METHODS A retrospective review of all MRgLITT procedures in our hospital was performed. All procedures were performed using a surgical laser ablation system. Demographic and outcome data were compiled and analyzed. RESULTS A total of 19 patients underwent MRgLITT procedures from June 2021 to November 2021. The average age at surgery was 18.1 years (3-61.4 years). The average length of hospitalization post-surgery was 4.95 days (4-7 days). Surgical substrates included 8 patients with hypothalamic hamartomas, 5 with medial temporal lobe epilepsy, 3 with deep focal cortical dysplasia, 1 with tuberous sclerosis, 1 with a cavernous malformation, and 1 with Lennox-Gastaut syndrome who underwent anterior corpus callosotomy. Complications occurred in three patients. After an average follow-up of 1 year, 6 patients were seizure-free (Engel I, 31.6%), 1 had significant seizure control (Engel II, 5.3%), 7 had seizure control (Engel III, 36.8%), and 5 had no improvement in their seizures (Engel IV, 26.3%). Fisher's exact tests did not reveal statistical significance for the association between Engel class outcome and epileptic disease. CONCLUSION This study confirmed that MRgLITT, as a method for treating drug-resistant epilepsy, is minimally invasive, safe, and efficient and that it can reduce the incidence of surgery-related complications.
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Affiliation(s)
- Hongchuan Niu
- Department of Neurosurgery, Peking University International Hospital, Beijing, China
| | - Kai Li
- Department of Neurosurgery, Peking University International Hospital, Beijing, China
| | - Xiaoning Liang
- Department of Neurosurgery, PKUCare Zibo Hospital, Shandong, China
| | - Desheng Kong
- Department of Neurosurgery, Peking University International Hospital, Beijing, China
| | - Zongze Li
- Department of Neurosurgery, Peking University International Hospital, Beijing, China
| | - Fengqiao Sun
- Department of Neurosurgery, Peking University International Hospital, Beijing, China
| | - Xianzeng Liu
- Department of Neurology, Peking University International Hospital, Beijing, China
| | - Zongsheng Xu
- Department of Neurosurgery, Peking University International Hospital, Beijing, China
| | - Xuejiao Wei
- Department of Neurosurgery, Peking University International Hospital, Beijing, China
| | - Shuang Lan
- Department of Neurosurgery, Peking University International Hospital, Beijing, China
| | - Changyu Lu
- Department of Neurosurgery, Peking University International Hospital, Beijing, China.
- Present Address: Department of Neurosurgery, Peking University International, No.1 Shengmingyuan Road, Zhongguancun Life Science Park, Changping District, Beijing, 102206, China.
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Sufianov A, Gonzalez-Lopez P, Simfukwe K, Martorell-Llobregat C, Iakimov IA, Sufianov RA, Mastronardi L, Borba LAB, Rangel CC, Forlizzi V, Campero A, Baldoncini M. Clinical and anatomical analysis of the epileptogenic spread patterns in focal cortical dysplasia patients. Surg Neurol Int 2023; 14:291. [PMID: 37680931 PMCID: PMC10481808 DOI: 10.25259/sni_210_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 07/07/2023] [Indexed: 09/09/2023] Open
Abstract
Background Focal cortical dysplasia (FCD) is one of the main causes of intractable epilepsy, which is amendable by surgery. During the surgical management of FCD, the understanding of its epileptogenic foci, interconnections, and spreading pathways is crucial for attaining a good postoperative seizure free outcome. Methods We retrospectively evaluated 54 FCD patients operated in Federal Center of Neurosurgery, Tyumen, Russia. The electroencephalogram findings were correlated to the involved brain anatomical areas. Subsequently, we analyzed the main white matter tracts implicated during the epileptogenic spreading in some representative cases. We prepared 10 human hemispheres using Klinger's method and dissected them through the fiber dissection technique. Results The clinical results were displayed and the main white matter tracts implicated in the seizure spread were described in 10 patients. Respective FCD foci, interconnections, and ectopic epileptogenic areas in each patient were discussed. Conclusion A strong understanding of the main implicated tracts in epileptogenic spread in FCD patient remains cardinal for neurosurgeons dealing with epilepsy. To achieve meaningful seizure freedom, despite the focal lesion resection, the interconnections and tracts should be understood and somehow disconnected to stop the spreading.
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Affiliation(s)
- Albert Sufianov
- Department of Neurosurgery, Federal Center of Neurosurgery, Tyumen, Russian Federation
| | - Pablo Gonzalez-Lopez
- Department of Neurosurgery, Hospital General Universitario de Alicante, Alicante, Spain
| | - Keith Simfukwe
- Department of Neurosurgery, First Moscow Medical University, Moscow, Russian Federation
| | | | - Iurii A. Iakimov
- Department of Neurosurgery, First Moscow Medical University, Moscow, Russian Federation
| | - Rinat A. Sufianov
- Department of Neurosurgery, First Moscow Medical University, Moscow, Russian Federation
| | | | - Luis A. B. Borba
- Department of Neurosurgery, Mackenzie Evangelical University Hospital, Curitiba, Parana, Brazil
| | - Carlos Castillo Rangel
- Department of Neurosurgery, Institute of Security and Social Services for State Workers (ISSSTE), Mexico City, Mexico
| | - Valeria Forlizzi
- Laboratory of Microsurgical Neuroanatomy, Second Chair of Gross Anatomy, School of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Alvaro Campero
- Department of Neurosurgery, Hospital Padilla de Tucuman, Tucuman, Argentina
| | - Matias Baldoncini
- Department of Neurosurgery, San Fernando Hospital, San Fernando, Argentina
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Shields JA, Greven ACM, Shivamurthy VKN, Dickey AS, Matthews RE, Laxpati NG, Alwaki A, Drane DL, Isbaine F, Willie JT, Bullinger KL, Gross RE. Stereoelectroencephalography-guided radiofrequency ablation of the epileptogenic zone as a treatment and predictor of future success of further surgical intervention. Epilepsia 2023; 64:2081-2093. [PMID: 37300533 PMCID: PMC11051685 DOI: 10.1111/epi.17673] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 05/25/2023] [Accepted: 05/31/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Stereoelectroencephalography (SEEG)-guided radiofrequency ablation (RFA) is increasingly being used as a treatment for drug-resistant localization-related epilepsy. The aim of this study is to analyze the successes and failures using RFA and how response correlates with surgical epilepsy treatment outcomes. METHODS We retrospectively reviewed 62 patients who underwent RFA via SEEG electrodes. After excluding five, the remaining 57 were classified into subgroups based on procedures and outcomes. Forty patients (70%) underwent a secondary surgical procedure, of whom 32 were delayed: 26 laser interstitial thermal therapy (LITT), five resection, one neuromodulation. We determined the predictive value of RFA outcome upon subsequent surgical outcome by categorizing the delayed secondary surgery outcome as success (Engel I/II) versus failure (Engel III/IV). Demographic information, epilepsy characteristics, and the transient time of seizure freedom after RFA were calculated for each patient. RESULTS Twelve of 49 patients (24.5%) who had RFA alone and delayed follow-up achieved Engel class I. Of the 32 patients who underwent a delayed secondary surgical procedure, 15 achieved Engel class I and nine Engel class II (24 successes), and eight were considered failures (Engel class III/IV). The transient time of seizure freedom after RFA was significantly longer in the success group (4 months, SD = 2.6) as compared to the failure group (.75 months, SD = 1.16; p < .001). Additionally, there was a higher portion of preoperative lesional findings in patients in the RFA alone and delayed surgical success group (p = .03) and a longer time to seizure recurrence in the presence of lesions (p < .05). Side effects occurred in 1% of patients. SIGNIFICANCE In this series, RFA provided a treatment during SEEG-guided intracranial monitoring that led to seizure freedom in ~25% of patients. Of the 70% who underwent delayed surgery, longer transient time of seizure freedom after RFA was predictive of the results of the secondary surgeries, 74% of which were LITT.
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Affiliation(s)
| | - Alex C M Greven
- Department of Neurosurgery, Emory University, Atlanta, Georgia, USA
| | | | - Adam S Dickey
- Department of Neurology, Emory University, Atlanta, Georgia, USA
| | | | - Neal G Laxpati
- Department of Neurosurgery, Emory University, Atlanta, Georgia, USA
| | | | - Daniel L Drane
- Department of Neurology, Emory University, Atlanta, Georgia, USA
| | - Faical Isbaine
- Department of Neurosurgery, Emory University, Atlanta, Georgia, USA
| | - Jon T Willie
- Department of Neurosurgery, Washington University, St. Louis, Missouri, USA
| | | | - Robert E Gross
- Department of Neurosurgery, Emory University, Atlanta, Georgia, USA
- Department of Neurology, Emory University, Atlanta, Georgia, USA
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Chen JS, Lamoureux AA, Shlobin NA, Elkaim LM, Wang A, Ibrahim GM, Obaid S, Harroud A, Guadagno E, Dimentberg E, Bouthillier A, Bernhardt BC, Nguyen DK, Fallah A, Weil AG. Magnetic resonance-guided laser interstitial thermal therapy for drug-resistant epilepsy: A systematic review and individual participant data meta-analysis. Epilepsia 2023; 64:1957-1974. [PMID: 36824029 DOI: 10.1111/epi.17560] [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: 10/28/2022] [Revised: 01/30/2023] [Accepted: 02/22/2023] [Indexed: 02/25/2023]
Abstract
Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) has emerged as a popular minimally invasive alternative to open resective surgery for drug-resistant epilepsy (DRE). We sought to perform a systematic review and individual participant data meta-analysis to identify independent predictors of seizure outcome and complications following MRgLITT for DRE. Eleven databases were searched from January 1, 2010 to February 6, 2021 using the terms "MR-guided ablation therapy" and "epilepsy". Multivariable mixed-effects Cox and logistic regression identified predictors of time to seizure recurrence, seizure freedom, operative complications, and postoperative neurological deficits. From 8705 citations, 46 studies reporting on 450 MRgLITT DRE patients (mean age = 29.5 ± 18.1 years, 49.6% female) were included. Median postoperative seizure freedom and follow-up duration were 15.5 and 19.0 months, respectively. Overall, 240 (57.8%) of 415 patients (excluding palliative corpus callosotomy) were seizure-free at last follow-up. Generalized seizure semiology (hazard ratio [HR] = 1.78, p = .020) and nonlesional magnetic resonance imaging (MRI) findings (HR = 1.50, p = .032) independently predicted shorter time to seizure recurrence. Cerebral cavernous malformation (CCM; odds ratio [OR] = 7.97, p < .001) and mesial temporal sclerosis/atrophy (MTS/A; OR = 2.21, p = .011) were independently associated with greater odds of seizure freedom at last follow-up. Operative complications occurred in 28 (8.5%) of 330 patients and were independently associated with extratemporal ablations (OR = 5.40, p = .012) and nonlesional MRI studies (OR = 3.25, p = .017). Postoperative neurological deficits were observed in 53 (15.1%) of 352 patients and were independently predicted by hypothalamic hamartoma etiology (OR = 5.93, p = .006) and invasive electroencephalographic monitoring (OR = 4.83, p = .003). Overall, MRgLITT is particularly effective in treating patients with well-circumscribed lesional DRE, such as CCM and MTS/A, but less effective in nonlesional cases or lesional cases with a more diffuse epileptogenic network associated with generalized seizures. This study identifies independent predictors of seizure freedom and complications following MRgLITT that may help further guide patient selection.
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Affiliation(s)
- Jia-Shu Chen
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Audrey-Anne Lamoureux
- Division of Pediatric Neurosurgery, Department of Surgery, Sainte Justine Hospital, University of Montreal, Montreal, Quebec, Canada
| | - Nathan A Shlobin
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Lior M Elkaim
- Division of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Andrew Wang
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - George M Ibrahim
- Division of Neurosurgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Sami Obaid
- Division of Pediatric Neurosurgery, Department of Surgery, Sainte Justine Hospital, University of Montreal, Montreal, Quebec, Canada
- Division of Neurosurgery, University of Montreal Hospital Center, Montreal, Quebec, Canada
| | - Adil Harroud
- Division of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
- Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Elena Guadagno
- Harvey E. Beardmore Division of Pediatric Surgery, McGill University Health Center, Montreal, Quebec, Canada
| | - Evan Dimentberg
- Division of Pediatric Neurosurgery, Department of Surgery, Sainte Justine Hospital, University of Montreal, Montreal, Quebec, Canada
- Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
| | - Alain Bouthillier
- Division of Neurosurgery, University of Montreal Hospital Center, Montreal, Quebec, Canada
| | - Boris C Bernhardt
- McConnell Brain Imaging Center, Montreal Neurological Institute and Hospital, McGill University, Quebec, Canada
| | - Dang K Nguyen
- Division of Neurology, University of Montreal Medical Center, Montreal, Quebec, Canada
| | - Aria Fallah
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Alexander G Weil
- Division of Pediatric Neurosurgery, Department of Surgery, Sainte Justine Hospital, University of Montreal, Montreal, Quebec, Canada
- Division of Neurosurgery, University of Montreal Hospital Center, Montreal, Quebec, Canada
- Brain and Child Development Axis, Sainte Justine Research Center, Montreal, Quebec, Canada
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10
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Shoubash L, Nowak S, Greisert S, Al Menabbawy A, Rathmann E, von Podewils F, Fleck S, Schroeder HHW. Cavernoma-Related Epilepsy: Postoperative Epilepsy Outcome and Analysis of the Predictive Factors, Case Series. World Neurosurg 2023; 172:e499-e507. [PMID: 36693619 DOI: 10.1016/j.wneu.2023.01.062] [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: 11/05/2022] [Revised: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 01/22/2023]
Abstract
BACKGROUND Epilepsy is common in patients harboring cavernous malformation, and surgery is reported to be an effective treatment. However, few patients still experience seizures after surgery. We analyzed the outcome and predictive factors after cavernoma-related epilepsy (CRE) surgery. METHODS A database was created for all patients with CRE treated surgically from 2003 to 2020 at a university hospital. A chart review, perioperative epilepsy workup, surgical strategies, and postoperative and follow-up notes were analyzed. Postoperative seizure outcome was evaluated according to the Engel classification. RESULTS Thirty-seven patients (40.5% women; mean age 39.1 ± 14.5 years) were studied. The mean follow-up time was 5.6 ± 3.9 years. Among 37 patients, 32 (86.5%) achieved Engel class I at the last follow-up. Engel class II was found in 1 (2.7%), Engel class III in 1 (2.7%), and Engel class IV in 3 (8.1%) cases. Engel class Ia was observed in 23 patients (62.2%). None of the patients had a worse seizure outcome after the operation (Engel class IVc). Univariate and multivariate analysis showed that short-standing, sporadic, or low-frequent (≤3) seizures were the only variables significantly associated with seizure freedom, whereas longstanding, drug-resistant, or high-frequent seizure history were associated with worse seizure outcomes. CONCLUSIONS Surgical treatment results in favorable seizure control in most patients after CRE surgery. Long duration of epilepsy before surgery, high seizure frequency, and drug-resistant epilepsy could have a negative effect on seizure outcome (Engel class II-IV). Therefore, early surgical resection of the cavernoma after careful presurgical planning is recommended to achieve an optimal result.
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Affiliation(s)
- Loay Shoubash
- Department of Neurosurgery, University Medicine of Greifswald, Greifswald, Germany.
| | - Stephan Nowak
- Department of Neurosurgery, University Medicine of Greifswald, Greifswald, Germany
| | - Stephan Greisert
- Department of Neurosurgery, University Medicine of Greifswald, Greifswald, Germany
| | - Ahmed Al Menabbawy
- Department of Neurosurgery, University Medicine of Greifswald, Greifswald, Germany
| | - Eico Rathmann
- Department of Neuroradiology, University Medicine of Greifswald, Greifswald, Germany
| | - Felix von Podewils
- Department of Neurology, Epilepsy Center, University Medicine of Greifswald, Greifswald, Germany
| | - Steffen Fleck
- Department of Neurosurgery, University Medicine of Greifswald, Greifswald, Germany
| | - Henry H W Schroeder
- Department of Neurosurgery, University Medicine of Greifswald, Greifswald, Germany
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11
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Mirone G, Cicala D, Cinalli G. Posterior Fossa Laser Interstitial Thermal Therapy in Children. Neurosurg Clin N Am 2023; 34:227-237. [PMID: 36906329 DOI: 10.1016/j.nec.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Real-time, MRI-guided laser interstitial thermal therapy (MRgLITT) is emerging as a minimally invasive technique for epilepsy surgery and for deep-seated tumors in the pediatric population. However, MRgLITT for posterior fossa lesions poses a unique challenge that is especially evident in this age range and remains understudied. In this study, we report our experience and analyze the current literature on MRgLITT for the treatment of posterior fossa in children.
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Affiliation(s)
- Giuseppe Mirone
- Department of Pediatric Neurosurgery, Santobono-Pausilipon Children's Hospital, AORN, Via Mario Fiore 6 80121, Napoli, Italy
| | - Domenico Cicala
- Department of Pediatric Neurosurgery, Santobono-Pausilipon Children's Hospital, AORN, Via Mario Fiore 6 80121, Napoli, Italy
| | - Giuseppe Cinalli
- Department of Pediatric Neurosurgery, Santobono-Pausilipon Children's Hospital, AORN, Via Mario Fiore 6 80121, Napoli, Italy.
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12
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The use of stereotactic MRI-guided laser interstitial thermal therapy for the treatment of pediatric cavernous malformations: the SUNY Upstate Golisano Children's Hospital experience. Childs Nerv Syst 2023; 39:417-424. [PMID: 36416952 DOI: 10.1007/s00381-022-05701-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 10/03/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE Cavernous malformations (CM) are central nervous system lesions characterized by interlaced vascular sinusoids coated with endothelial cells without intervening parenchyma. Magnetic resonance imaging-guided laser interstitial thermal therapy (MRIgLITT) is a minimally invasive treatment modality that can precisely treat pathologic cerebral tissue, making it an effective alternative for the management of cavernomas. We describe the outcomes of a series of pediatric patients with cavernous brain malformations treated with MRIgLITT between 2014 and 2018 at our institution. METHODS We retrospectively analyzed 11 cavernomas in 6 pediatric patients treated with MRIgLITT. Both the Visualase System® and/or Neuroblate® systems were used. A variation of the surgical technique on the application of the laser was developed. Post-ablation MRIs were obtained to assess ablated areas. RESULTS A total of 11 cavernomas in 6 patients were treated with MRIgLITT. Median age was 15 years (12 to 17 years); 75% were males. Presenting symptoms were headache (75%) and seizures (25%). Two patients presented with multiple CMs. All lesions in this study were supratentorial (cerebral hemispheres 81.8%, corpus callosum 9.1%, basal ganglia 9.1%). Our surgical technique was well-tolerated, with no significant adverse events observed. Hospital stay for all patients was less than 48 hours. CONCLUSION MRIgLITT is an effective minimally invasive technique for the treatment of pediatric CMs. It represents a useful and safe tool, when other therapeutic alternatives may represent a greater risk of surgical morbidity.
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13
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Hamade YJ, Mehrotra A, Chen CC. Stereotactic needle biopsy and laser ablation of geographically distinct lesions through a novel magnetic resonance imaging-compatible cranial stereotaxic frame: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2023; 5:CASE22448. [PMID: 36624633 PMCID: PMC9830414 DOI: 10.3171/case22448] [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: 10/16/2022] [Accepted: 11/17/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Current technologies that support stereotactic laser ablation (SLA) of geographically distinct lesions require placement of multiple bolts or time-consuming, intertrajectory adjustments. OBSERVATIONS Two geographically distinct nodular lesions were safely biopsied and laser ablated in a 62-year-old woman with recurrent glioblastoma using the ClearPoint Array frame, a novel magnetic resonance imaging-compatible stereotactic frame designed to support independent parallel trajectories without intertrajectory frame adjustment. LESSONS Here, the authors provide a proof-of-principle case report demonstrating that geographically distinct lesions can be safely biopsied and ablated through parallel trajectories supported by the ClearPoint Array frame without intertrajectory adjustment.
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Affiliation(s)
- Youssef J. Hamade
- Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota; and
| | - Avanti Mehrotra
- Department of Oncology, North Memorial Health, Minneapolis, Minnesota
| | - Clark C. Chen
- Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota; and
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14
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Ogasawara C, Watanabe G, Young K, Kwon R, Conching A, Palmisciano P, Kan P, de Oliveira Sillero R. Laser Interstitial Thermal Therapy for Cerebral Cavernous Malformations: A Systematic Review of Indications, Safety, and Outcomes. World Neurosurg 2022; 166:279-287.e1. [PMID: 35760323 DOI: 10.1016/j.wneu.2022.06.052] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/09/2022] [Accepted: 06/10/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Cerebral cavernous malformations (CCM) in deep eloquent areas present a surgical challenge. Laser interstitial thermal therapy (LITT) may present itself as a safe minimally invasive treatment option. OBJECTIVE To systematically review the indications, safety, and outcomes of LITT for CCM. METHODS Electronic databases were searched from inception to October 7, 2021 for articles with CCM and LITT keywords. Studies describing CCMs treated with LITT were included. RESULTS A total of 32 patients with CCMs in lobar (79%), basal ganglia (12%), and brainstem (9%) locations were treated with LITT. Indications for LITT included drug-resistant seizures (75%), unacceptable surgical risk (22%), recurrent hemorrhage (16%), and early intervention to discontinue antiepileptic drugs (3%). No death or CCM-associated intracranial hemorrhage occurred intraoperatively or postoperatively, and most patients experienced no adverse effects or transient effects that resolved at follow-up (84%). Of those treated for CCM-associated epilepsy, 83% experienced Engel class I seizure freedom and most were class IA (61%). Most patients experienced symptomatic improvement (93%), and a decrease in antiepileptic drugs was reported in more than half of patients (56%), with 28% able to discontinue all antiepilepsy medications after LITT. CONCLUSIONS LITT seems to be a safe treatment for CCMs located in deep eloquent areas and in lesions presenting with medically refractory seizures or recurrent hemorrhages. Randomized studies are needed to further elucidate its efficacy in treating CCM.
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Affiliation(s)
- Christian Ogasawara
- Division of Neurosurgery, John A. Burns School of Medicine, University of Hawai'i, Honolulu, Hawai'i, USA.
| | - Gina Watanabe
- Division of Neurosurgery, John A. Burns School of Medicine, University of Hawai'i, Honolulu, Hawai'i, USA
| | - Kurtis Young
- Division of Neurosurgery, John A. Burns School of Medicine, University of Hawai'i, Honolulu, Hawai'i, USA
| | - Royce Kwon
- Division of Neurosurgery, John A. Burns School of Medicine, University of Hawai'i, Honolulu, Hawai'i, USA
| | - Andie Conching
- Division of Neurosurgery, John A. Burns School of Medicine, University of Hawai'i, Honolulu, Hawai'i, USA
| | - Paolo Palmisciano
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Peter Kan
- Department of Neurosurgery, University of Texas Medical Branch, Galveston, Texas, USA
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Lawrence JD, Rehman AA, Lee M. Treatment of a Pontine Cavernoma With Laser Interstitial Thermal Therapy: Case Report. NEUROSURGERY OPEN 2022. [DOI: 10.1227/neuopn.0000000000000013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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16
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Rauschenbach L, Bartsch P, Santos AN, Lenkeit A, Darkwah Oppong M, Wrede KH, Jabbarli R, Chmielewski WX, Schmidt B, Quesada CM, Forsting M, Sure U, Dammann P. Quality of life and mood assessment in conservatively treated cavernous malformation-related epilepsy. Brain Behav 2022; 12:e2595. [PMID: 35470577 PMCID: PMC9226805 DOI: 10.1002/brb3.2595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 03/03/2022] [Accepted: 04/04/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND To estimate the quality of life, anxiety, depression, and illness perception in patients with medically treated cerebral cavernous malformation (CCM) and associated epilepsy. METHODS Nonsurgically treated patients with CCM-related epilepsy (CRE) were included. Demographic, radiographic, and clinical features were assessed. All participants received established questionnaires (short-form 36 health survey, SF-36; hospital anxiety and depression score, HADS-A/D; visual analogue scale score, VAS) assessing the functional and psychosocial burden of disease. To some extent, calculated values were compared with reference values from population-based studies. Test results were related to seizure control. RESULTS A total of 37 patients were included. Mean age was 45.8 ± 14.4 years, and 54.1% were female. Diagnosis of CRE was significantly associated with attenuated quality of life and increased level of anxiety, affecting physical and psychosocial dimensions. The assessment of illness perception identified considerable burden. HADS was significantly associated with VAS and SF-36 component scores. Efficacy of antiepileptic medication had no restoring impact on quality of life, anxiety, depression, or illness perception. CONCLUSIONS CRE negatively influences quality of life and mood, independent of seizure control due to antiepileptic medication. Screening for functional and psychosocial deficits in clinical practice might be useful for assessing individual burden and allocating surgical or drug treatment.
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Affiliation(s)
- Laurèl Rauschenbach
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany
| | - Pauline Bartsch
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany
| | - Alejandro N Santos
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany
| | - Annika Lenkeit
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany
| | - Marvin Darkwah Oppong
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany
| | - Karsten H Wrede
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany
| | - Ramazan Jabbarli
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany
| | - Witold X Chmielewski
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany
| | - Börge Schmidt
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, Essen, Germany
| | - Carlos M Quesada
- Department of Neurology, Division of Epilepsy, University Hospital Essen, Essen, Germany
| | - Michael Forsting
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Ulrich Sure
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany
| | - Philipp Dammann
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany
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17
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Yousefi O, Sabahi M, Malcolm J, Adada B, Borghei-Razavi H. Laser Interstitial Thermal Therapy for Cavernous Malformations: A Systematic Review. Front Surg 2022; 9:887329. [PMID: 35647010 PMCID: PMC9136030 DOI: 10.3389/fsurg.2022.887329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 04/27/2022] [Indexed: 11/18/2022] Open
Abstract
Background Microsurgical resection of intracranial cavernous malformations (CM) is regarded as the standard treatment, but in recent years, there has been a trend toward minimally invasive procedures like ablation of such lesions by using laser interstitial thermal therapy (LITT). Methods A systematic search using keywords ‘laser interstitial thermal therapy’ OR ‘LITT’ AND ‘cavernoma’ OR ‘cavernous angiomas’ OR ‘cavernous malformations’ was conducted in MEDLINE (PubMed), Scopus, Embase, and Cochrane electronic bibliographic databases and studies reporting the outcome of LITT procedure on intracranial CM were included. The demographic data, symptoms of patients, location and size of the lesion, and surgical outcome were extracted from the articles. Result Six studies, reporting the outcome of 33 patients were included in this review. In 26 patients, CM was identified as the epileptogenic foci and in others, CM was the source of headache or focal neurological deficits. LITT led to a satisfactory outcome in all patients except for three who achieved improvement in symptoms after the open resection of the lesion. Most of the post-operative complications were transient and resolved at the time of the last follow up. Cyst formation at the previous ablated CM site was reported as the long-term complication of LITT in one case. Conclusion LITT can provide a comparable outcome to the open resection of CMs, by having less invasiveness, even in deep and eloquent area lesions, and complications that are often temporary and disappear gradually. However, technical issues, such as thermal monitoring during the procedure, are considered a challenge for this procedure in CMs. Further studies with a larger population are needed to report this method's long-term outcome and complications on CMs.
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Affiliation(s)
- Omid Yousefi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammadmahdi Sabahi
- Neurosurgery Research Group (NRG), Student Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran
| | - James Malcolm
- Department of Neurosurgery, Emory University, Atlanta, GA, United States
| | - Badih Adada
- Department of Neurological Surgery, Pauline Braathen Neurological Center, Cleveland Clinic Florida, Weston, FL, United States
| | - Hamid Borghei-Razavi
- Department of Neurological Surgery, Pauline Braathen Neurological Center, Cleveland Clinic Florida, Weston, FL, United States
- Correspondence: Hamid Borghei-Razavi
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18
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Hedaya AA, Hewitt KC, Hu R, Epstein CM, Gross RE, Drane DL, Willie JT. Open surgery or laser interstitial thermal therapy for low-grade epilepsy-associated tumors of the temporal lobe: A single-institution consecutive series. Epilepsy Behav 2022; 130:108659. [PMID: 35339067 PMCID: PMC9361400 DOI: 10.1016/j.yebeh.2022.108659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 02/07/2022] [Accepted: 03/02/2022] [Indexed: 11/16/2022]
Abstract
Outcomes of treating low-grade epilepsy-associated tumors (LEATs) in the temporal lobe with MRI-guided laser interstitial thermal therapy (MRgLITT) remain poorly characterized. This study aimed to compare the safety and effectiveness of treating temporal lobe LEATs with MRgLITT versus open resection in a consecutive single-institution series. We reviewed all adult patients with epilepsy that underwent surgery for temporal lobe LEATs at our institution between 2002 and 2019, during which time we switched from open surgery to MRgLITT. Surgical outcome was categorized by Engel classification at >12mo follow-up and Kaplan-Meir analysis of seizure freedom. We recorded hospital length of stay, adverse events, and available neuropsychological results. Of 14 total patients, 7 underwent 9 open resections, 6 patients underwent MRgLITT alone, and 1 patient underwent an open resection followed by MRgLITT. Baseline group demographics differed and were notable for preoperative duration of epilepsy of 9.0 years (range 1-36) for open resection versus 14.0 years (range 2-34) for MRgLITT. Median length of stay was one day shorter for MRgLITT compared to open resection (p=<.0001). There were no major adverse events in the series, but there were fewer minor adverse events following MRgLITT. At 12mo follow-up, 50% (5/10) of patients undergoing open resection and 57% (4/7) of patients undergoing MRgLITT were free of disabling seizures (Engel I). When comparing patients who underwent similar procedures in the dominant temporal lobe, patients undergoing MRgLITT had fewer and milder material-specific neuropsychological declines than patients undergoing open resections. In this small series, MRgLITT was comparably safe and effective relative to open resection of temporal lobe LEATs.
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Affiliation(s)
- Alexander A Hedaya
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, United States
| | - Kelsey C Hewitt
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States
| | - Ranliang Hu
- Department of Radiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Charles M Epstein
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States
| | - Robert E Gross
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, United States; Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States
| | - Daniel L Drane
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States; Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States; Department of Neurology, University of Washington, Seattle, WA, United States
| | - Jon T Willie
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, United States; Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States; Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, United States.
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19
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Liu W, Liu M, Lu D, Wang J, Cao Z, Liu X, Feng Z, Huang B, Wang X. A Chinese Family With Cerebral Cavernous Malformation Caused by a Frameshift Mutation of the CCM1 Gene: A Case Report and Review of the Literature. Front Neurol 2022; 13:795514. [PMID: 35444609 PMCID: PMC9013744 DOI: 10.3389/fneur.2022.795514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 01/10/2022] [Indexed: 11/29/2022] Open
Abstract
Background Familial cerebral cavernous malformation (FCCM) is a vascular malformation disease closely linked to three identified genes: KRIT1/CCM1, MGC4607/CCM2 and PDCD10/CCM3. Over the past decade, a few cases of cerebral cavernous malformation (CCM) caused by different gene mutations have been reported in Chinese families. Herein, we introduce a Chinese family affected by FCCM due to a kind of KRIT1/CCM1 frameshift mutation. At the same time, a literature review was conducted to identify case reports of familial cerebral cavernous malformation. Case presentation The proband in the family in question demonstrated a series of clinical symptoms and features, including headache and bleeding. The proband was hospitalized for headache twice and, both times was examined under suspicion of CCM and received surgical treatment. Magnetic resonance imaging results showed that the proband had multiple intracranial vascular lesions, including on the brain, brainstem, and cerebellum. Genetic test results showed that the classic KRIT1 gene in the proband had a pathogenic mutation. The family members of the proband also showed typical cerebral cavernous malformation when considering clinical manifestations, magnetic resonance imaging findings and genetic test results. Conclusions We report a case of Chinese FCCM and its associated symptoms with CCM1-deletion mutations in China. Our findings deepen our understanding of CCM mutations and related phenotypes, the investigation results of this clinical experiment further show that the gene mutation form we reported plays an important role in human FCCM, and this trial investigation is beneficial for genetic counseling for CCM patients.
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Affiliation(s)
- Wenyu Liu
- Department of Neurosurgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University and Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, China
- Key Laboratory of Brain Function Remodeling, Qilu Hospital of Shandong University, Jinan, China
| | - Ming Liu
- Department of Neurosurgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University and Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, China
- Key Laboratory of Brain Function Remodeling, Qilu Hospital of Shandong University, Jinan, China
| | - Di Lu
- Department of Neurosurgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University and Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, China
- Key Laboratory of Brain Function Remodeling, Qilu Hospital of Shandong University, Jinan, China
| | - Jiwei Wang
- Department of Neurosurgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University and Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, China
- Key Laboratory of Brain Function Remodeling, Qilu Hospital of Shandong University, Jinan, China
| | - Zexin Cao
- Department of Neurosurgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University and Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, China
- Key Laboratory of Brain Function Remodeling, Qilu Hospital of Shandong University, Jinan, China
| | - Xuchen Liu
- Department of Neurosurgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University and Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, China
- Key Laboratory of Brain Function Remodeling, Qilu Hospital of Shandong University, Jinan, China
| | - Zichao Feng
- Department of Neurosurgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University and Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, China
- Key Laboratory of Brain Function Remodeling, Qilu Hospital of Shandong University, Jinan, China
| | - Bin Huang
- Department of Neurosurgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University and Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, China
- Key Laboratory of Brain Function Remodeling, Qilu Hospital of Shandong University, Jinan, China
| | - Xinyu Wang
- Department of Neurosurgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University and Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, China
- Key Laboratory of Brain Function Remodeling, Qilu Hospital of Shandong University, Jinan, China
- *Correspondence: Xinyu Wang
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Wu C, Schwalb JM, Rosenow JM, McKhann GM, Neimat JS. The American Society for Stereotactic and Functional Neurosurgery Position Statement on Laser Interstitial Thermal Therapy for the Treatment of Drug-Resistant Epilepsy. Neurosurgery 2022; 90:155-160. [PMID: 34995216 DOI: 10.1227/neu.0000000000001799] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 09/29/2021] [Indexed: 11/19/2022] Open
Abstract
Magnetic resonance image-guided laser interstitial thermal therapy (MRgLITT) is a novel tool in the neurosurgical armamentarium for the management of drug-resistant epilepsy. Given the recent introduction of this technology, the American Society for Stereotactic and Functional Neurosurgery (ASSFN), which acts as the joint section representing the field of stereotactic and functional neurosurgery on behalf of the Congress of Neurological Surgeons and the American Association of Neurological Surgeons, provides here the expert consensus opinion on evidence-based best practices for the use and implementation of this treatment modality. Indications for treatment are outlined, consisting of failure to respond to, or intolerance of, at least 2 appropriately chosen medications at appropriate doses for disabling, localization-related epilepsy in the setting of well-defined epileptogenic foci, or critical pathways of seizure propagation accessible by MRgLITT. Applications of MRgLITT in mesial temporal lobe epilepsy and hypothalamic hamartoma, along with its contraindications in the treatment of epilepsy, are discussed based on current evidence. To put this position statement in perspective, we detail the evidence and authority on which this ASSFN position statement is based.
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Affiliation(s)
- Chengyuan Wu
- Department of Neurological Surgery, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Jason M Schwalb
- Department of Neurological Surgery, Henry Ford Health System, Detroit, Michigan, USA
| | - Joshua M Rosenow
- Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Guy M McKhann
- Department of Neurological Surgery, Neurological Institute of New York, Columbia University Medical Center, New York, New York, USA
| | - Joseph S Neimat
- Department of Neurological Surgery, University of Louisville, Louisville, Kentucky, USA
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Sinha SR, Yang JC, Wallace MJ, Grover K, Johnson FR, Reed SD. Patient preferences pertaining to treatment options for drug-resistant focal epilepsy. Epilepsy Behav 2022; 127:108529. [PMID: 35016055 DOI: 10.1016/j.yebeh.2021.108529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 12/21/2021] [Accepted: 12/23/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine patient acceptability of benefit-risk trade-offs in selecting treatment options for drug-resistant mesial temporal lobe epilepsy, including open brain surgery, laser ablation (laser interstitial thermal therapy [LITT]), and continued medications. METHODS A discrete-choice experiment survey was developed, consisting of 20 versions that were randomly assigned to respondents. Each version had 8 sets of constructed treatment alternatives, representing open brain surgery, LITT, or continued medical management. For each set, respondents indicated the treatment alternative they would choose first. Treatment alternatives were characterized by varying levels of chance of seizure freedom for at least 2 years (20-70%), risk of 30-day mortality (0-10%), and risk of neurological deficits (0-40%). Respondents' choices were analyzed using random-parameters logit models to quantify acceptable benefit-risk trade-offs. Preference heterogeneity was evaluated using latent-class analysis. RESULTS The survey was administered to 2 cohorts of adult patients with drug-resistant epilepsy: a Duke cohort identified using diagnostic codes (n = 106) and a web-recruited panel with a self-reported physician diagnosis of drug-resistant epilepsy (n = 300). Based on mean preference weights, respondents who indicated a willingness to consider surgical intervention would accept a reduction in chance of seizure freedom from 70% to a minimum-acceptable benefit (MAB) of 23% if they could undergo LITT rather than open brain surgery. For a reduction in 30-day mortality from 1% to 0%, MAB was 52%. For a reduction in risk of long-term deficits from 10% to 0%, MAB was 39%. Latent-class analysis revealed additional choice patterns identifying respondent groups that more strongly favored continuing medications or undergoing surgery. CONCLUSION Patients who are receptive to surgery would accept significantly lower treatment effectiveness to undergo a minimally invasive procedure relative to open brain surgery. They also were willing to accept lower treatment benefit to reduce risks of mortality or neurological deficits.
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Affiliation(s)
- Saurabh R Sinha
- Department of Neurology, Duke University School of Medicine, Durham, NC, USA
| | - Jui-Chen Yang
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Matthew J Wallace
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Kiran Grover
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - F Reed Johnson
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA; Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Shelby D Reed
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA; Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.
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22
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Barot N, Batra K, Zhang J, Klem ML, Castellano J, Gonzalez-Martinez J, Bagic A. Surgical outcomes between temporal, extratemporal epilepsies and hypothalamic hamartoma: systematic review and meta-analysis of MRI-guided laser interstitial thermal therapy for drug-resistant epilepsy. J Neurol Neurosurg Psychiatry 2022; 93:133-143. [PMID: 34321344 DOI: 10.1136/jnnp-2021-326185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 06/20/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Approximately 1/3 of patients with epilepsy have drug-resistant epilepsy (DRE) and require surgical interventions. This meta-analysis aimed to review the effectiveness of MRI-guided laser interstitial thermal therapy (MRgLITT) in DRE. METHODS The Population, Intervention, Comparator and Outcome approach and Preferred Reporting Items for Systematic Reviews and Meta-Analyses were followed. PubMed, MEDLINE and EMBASE databases were systematically searched for English language publications from 2012 to Nov 2020. Data on the prevalence outcome using the Engel Epilepsy Surgery Outcome Scale (Class I-IV), and postoperative complications were analysed with 95% CIs. RESULTS Twenty-eight studies that included a total of 559 patients with DRE were identified. The overall prevalence of Engel class I outcome was 56% (95% CI 0.52% to 0.60%). Hypothalamic hamartomas (HH) patients had the highest seizure freedom rate of 67% (95% CI 0.57% to 0.76%) and outcome was overall comparable between mesial temporal lobe epilepsy (mTLE) (56%, 95% CI 0.50% to 0.61%) and extratemporal epilepsy (50% 95% CI 0.40% to 0.59%). The mTLE cases with mesial temporal sclerosis had better outcome vs non-lesional cases of mTLE. The prevalence of postoperative adverse events was 19% (95% CI 0.14% to 0.25%) and the most common adverse event was visual field deficits. The reoperation rate was 9% (95% CI 0.05% to 0.14%), which included repeat ablation and open resection. CONCLUSION MRgLITT is an effective and safe intervention for DRE with different disease aetiologies. The seizure freedom outcome is overall comparable in between extratemporal and temporal lobe epilepsy; and highest with HH. TRAIL REGISTRATION NUMBER The study protocol was registered with the National Institute for Health Research (CRD42019126365), which serves as a prospective register of systematic reviews. It is an international database of prospectively registered systematic reviews with a focus on health-related outcomes. Details about the protocol can be found at https://wwwcrdyorkacuk/PROSPERO/.
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Affiliation(s)
- Niravkumar Barot
- Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Kavita Batra
- Office of Research, University of Nevada, Las vegas, Nevada, USA
| | - Jerry Zhang
- University of Pittsburgh, Biostatistical Consulting Laboratory, Pittsburgh, Pennsylvania, USA
| | - Mary Lou Klem
- Library System, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - James Castellano
- Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Anto Bagic
- Neurology, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
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23
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Gilbert OE, Wilson JM, Volk JM. Giant Frontotemporal Cavernous Malformation in a 2-Month-Old Infant: A Case Report and Review of the Literature. Pediatr Neurosurg 2022; 57:56-62. [PMID: 34749375 DOI: 10.1159/000519856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 09/23/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Cavernous malformations in the pediatric population are exceedingly rare, especially in infants. Giant cavernous malformations (GCM) are even more rare and have a diameter >4 cm. The onset of symptoms predominantly occurs in adulthood, but the rate of hemorrhage is significantly higher in the pediatric population. Similar to non-GCM, GCM can be misidentified as tumors on imaging due to their tumefactive pattern with edema. Here, we present a rare case of a right frontotemporal GCM in a 2-month-old girl, the youngest recorded case in the existing literature. CASE PRESENTATION A previously healthy 2-month-old girl presented to the emergency department following an increasing frequency of seizure-like activity that began 3 days prior to presentation. Magnetic resonance imaging of the brain with and without contrast characterized a large (5.8 × 4.3 × 4.2 cm) heterogeneous lesion of the right temporal lobe with diffuse scattered blood products of various ages seen throughout the lesion. She underwent a right-sided craniotomy where a gross total excision was achieved. Pathology confirmed the diagnoses of a GCM. The patient's seizures subsequently resolved, and she continues to do well postoperatively. DISCUSSION/CONCLUSION GCM can be mistaken for tumors due to their large size, cystic nature, and surrounding edema, but a vascular lesion should always remain in the differential diagnosis before operating, even in infants. Surgery is generally recommended in patients that present with a symptomatic hemorrhage, recurrent hemorrhages, persistent seizures despite medical management, or progressively worsening neurological deficits if the GCM is in a safe location. It has been shown that 70-99% of patients undergoing surgery with successful removal of the GCM can achieve seizure freedom 2 years postoperatively. Complete surgical excision of this infant's GCM was successful in treating her neurologic symptoms; therefore, pathological confirmation of this lesion is critical and should prompt a complete surgical excision.
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Affiliation(s)
- Olivia E Gilbert
- School of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA,
| | - John M Wilson
- Department of Neurosurgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Jerome M Volk
- Department of Neurosurgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
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24
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Surgical Management of Cavernous Malformations and Venous Anomalies. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00075-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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25
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Consales A, Cognolato E, Pacetti M, Mancardi MM, Tortora D, Di Perna G, Piatelli G, Nobili L. Magnetic Resonance-Guided Laser Interstitial Thermal Therapy (MR-gLiTT) in Pediatric Epilepsy Surgery: State of the Art and Presentation of Giannina Gaslini Children's Hospital (Genoa, Italy) Series. Front Neurol 2021; 12:739034. [PMID: 34764929 PMCID: PMC8577648 DOI: 10.3389/fneur.2021.739034] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 09/27/2021] [Indexed: 11/13/2022] Open
Abstract
Magnetic resonance-guided laser interstitial thermal therapy (MR-gLiTT) is a novel minimally invasive treatment approach for drug-resistant focal epilepsy and brain tumors. Using thermal ablation induced by a laser diode implanted intracranially in a stereotactic manner, the technique is highly effective and safe, reducing the risk associated with more traditional open surgical approaches that could lead to increased neurological morbidity. Indications for MR-gLiTT in pediatric epilepsy surgery include hypothalamic hamartoma, tuberous sclerosis complex, cavernoma-related epilepsy, SEEG-guided seizure onset zone ablation, corpus callosotomy, periventricular nodular heterotopia, mesial temporal lobe epilepsy, and insular epilepsy. We review the available literature on the topic and present our series of patients with drug-resistant epilepsy treated by MR-gLiTT. Our experience, represented by six cases of hypothalamic hamartomas, one case of tuberous sclerosis, and one case of dysembryoplastic neuroepithelial tumor, helps to confirm that MR-gLiTT is a highly safe and effective procedure for several epilepsy conditions in children.
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Affiliation(s)
- Alessandro Consales
- Unit of Neurosurgery, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Genoa, Italy
| | - Erica Cognolato
- DINOGMI, University of Genoa, Genoa, Italy.,Unit of Child Neuropsychiatry, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Genoa, Italy
| | - Mattia Pacetti
- Unit of Neurosurgery, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Genoa, Italy.,DINOGMI, University of Genoa, Genoa, Italy
| | - Maria Margherita Mancardi
- Unit of Child Neuropsychiatry, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Genoa, Italy
| | - Domenico Tortora
- Unit of Neuroradiology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Genoa, Italy
| | - Giuseppe Di Perna
- Unit of Neurosurgery, Azienda Ospedaliera Universitaria (AOU) Città della Scienza e della Salute, University of Turin, Turin, Italy
| | - Gianluca Piatelli
- Unit of Neurosurgery, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Genoa, Italy
| | - Lino Nobili
- DINOGMI, University of Genoa, Genoa, Italy.,Unit of Child Neuropsychiatry, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Genoa, Italy
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26
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Wu X, Chen W, Lin Y, Liang R. The Impact of Volume Factor on the Long-Term Outcome of Gamma Knife Radiosurgery for Sporadic Cerebral Cavernous Malformations. World Neurosurg 2021; 158:e627-e635. [PMID: 34775093 DOI: 10.1016/j.wneu.2021.11.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 11/05/2021] [Accepted: 11/06/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE We aimed to evaluate the long-term outcome of gamma knife radiosurgery (GKRS) for the treatment of sporadic cerebral cavernous malformation (CCM), especially the influence of lesion volume on annual hemorrhage rate (AHR) of patients with CCM after GKRS. METHODS Fifty-one single-lesion patients with a history of hemorrhage who underwent radiosurgery at our institution were included and divided into 2 groups (A and B), based on their lesion volume. Group A included 25 patients with lesion volumes >1 cm3, whereas group B included 26 patients with lesion volumes ≤1 cm3. The clinical data of the patients were retrospectively analyzed. RESULTS All patients were followed up for more than 4 years after GKRS. The calculated AHR before GKRS was 18.49% in group A and 10.16% in group B. The calculated AHR after GKRS was 5.43% and 0.99% for groups A and B, respectively. Significant differences in AHR after GKRS were identified between group A and group B (P = 0.011). Thirty-seven patients with sporadic CCM (14 in group A, 23 in group B) experienced symptom improvement, and significant differences in symptom improvement were observed between group A and group B (P = 0.009). CONCLUSIONS GKRS decreased the risk of hemorrhage and was beneficial for symptomatic improvement in patients with sporadic CCM with a history of hemorrhage. The long-term clinical outcomes for patients with sporadic CCM with small lesion volumes (≤1 cm3) were better than those of patients with sporadic CCM with large lesion volumes (>1 cm3).
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Affiliation(s)
- Xiyao Wu
- Department of Neurosurgery, Fujian Medical University Union Hospital, Neurosurgical Institute of Fujian Province, Fuzhou, Fujian, China
| | - Weitao Chen
- Department of Neurosurgery, Fujian Medical University Union Hospital, Neurosurgical Institute of Fujian Province, Fuzhou, Fujian, China
| | - Yaojing Lin
- Department of Neurosurgery, Fujian Medical University Union Hospital, Neurosurgical Institute of Fujian Province, Fuzhou, Fujian, China
| | - Risheng Liang
- Department of Neurosurgery, Fujian Medical University Union Hospital, Neurosurgical Institute of Fujian Province, Fuzhou, Fujian, China.
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27
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Guglielmi G, Eschbach KL, Alexander AL. Smaller Knife, Fewer Seizures? Recent Advances in Minimally Invasive Techniques in Pediatric Epilepsy Surgery. Semin Pediatr Neurol 2021; 39:100913. [PMID: 34620456 DOI: 10.1016/j.spen.2021.100913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/09/2021] [Accepted: 08/11/2021] [Indexed: 02/02/2023]
Abstract
Children with drug-resistant epilepsy are at high risk for developmental delay, increased mortality, psychiatric comorbidities, and requiring assistance with activities of daily living. Despite the advent of new and effective pharmacologic therapies, about one in 5 children will develop drug-resistant epilepsy, and most of these children continue to have seizures despite trials of other medication. Epilepsy surgery is often a safe and effective option which may offer seizure freedom or at least a significant reduction in seizure burden in many children. However, despite published evidence of safety and efficacy, epilepsy surgery remains underutilized in the pediatric population. Patient and family fears about the risks of surgery may contribute to this gap. Less invasive surgical techniques may be more palatable to children with epilepsy and their caregivers. In this review, we present recent advances in minimally invasive techniques for the surgical treatment of epilepsy as well as intriguing possibilities for the future. We describe the indications for, benefits of, and limits to minimally-invasive techniques including Stereo-encephalography, laser interstitial thermal ablation, deep brain stimulation, focused ultrasound, stereo-encephalography-guided radiofrequency ablation, endoscopic disconnections, and responsive neurostimulation.
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Affiliation(s)
- Gina Guglielmi
- Graduate Medical Education, Neurological Surgery Residency, Carle BroMenn Medical Center, Normal IL; Section of Pediatric Neurology, Children's Hospital Colorado, Aurora CO; Department of Pediatrics, University of Colorado Anschutz School of Medicine, Aurora CO; Division of Pediatric Neurosurgery, Children's Hospital Colorado, Aurora CO; Department of Neurosurgery, University of Colorado Anschutz School of Medicine, Aurora CO
| | - Krista L Eschbach
- Graduate Medical Education, Neurological Surgery Residency, Carle BroMenn Medical Center, Normal IL; Section of Pediatric Neurology, Children's Hospital Colorado, Aurora CO; Department of Pediatrics, University of Colorado Anschutz School of Medicine, Aurora CO; Division of Pediatric Neurosurgery, Children's Hospital Colorado, Aurora CO; Department of Neurosurgery, University of Colorado Anschutz School of Medicine, Aurora CO
| | - Allyson L Alexander
- Graduate Medical Education, Neurological Surgery Residency, Carle BroMenn Medical Center, Normal IL; Section of Pediatric Neurology, Children's Hospital Colorado, Aurora CO; Department of Pediatrics, University of Colorado Anschutz School of Medicine, Aurora CO; Division of Pediatric Neurosurgery, Children's Hospital Colorado, Aurora CO; Department of Neurosurgery, University of Colorado Anschutz School of Medicine, Aurora CO.
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28
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Rich CW, Fasano RE, Isbaine F, Saindane AM, Qiu D, Curry DJ, Gross RE, Willie JT. MRI-guided stereotactic laser corpus callosotomy for epilepsy: distinct methods and outcomes. J Neurosurg 2021; 135:770-782. [PMID: 33482642 DOI: 10.3171/2020.7.jns20498] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 07/15/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Several small series have described stereotactic MRI-guided laser interstitial thermal therapy for partial callosotomy of astatic and generalized tonic-clonic (GTC) seizures, especially in association with Lennox-Gastaut syndrome. Larger case series and comparison of distinct stereotactic methods for stereotactic laser corpus callosotomy (SLCC), however, are currently lacking. The objective of this study was to report seizure outcomes in a series of adult patients with epilepsy following anterior, posterior, and complete SLCC procedures and to compare the results achieved with a frameless stereotactic surgical robot versus direct MRI guidance frames. METHODS The authors retrospectively reviewed sequential adult epilepsy surgery patients who underwent SLCC procedures at a single institution. They describe workflows, stereotactic errors, percentage disconnection, hospitalization durations, adverse events, and seizure outcomes after performing anterior, posterior, and complete SLCC procedures using a frameless stereotactic surgical robot versus direct MRI guidance platforms. RESULTS Thirteen patients underwent 15 SLCC procedures. The median age at surgery was 29 years (range 20-49 years), the median duration of epilepsy was 21 years (range 9-48 years), and median postablation follow-up was 20 months (range 4-44 months). Ten patients underwent anterior SLCC with a median 73% (range 33%-80%) midsagittal length of callosum acutely ablated. Following anterior SLCC, 6 of 10 patients achieved meaningful (> 50%) reduction of target seizures. Four patients underwent posterior (completion) SLCC following prior anterior callosotomy, and 1 patient underwent complete SLCC as a single procedure; 3 of these 5 patients experienced meaningful reduction of target seizures. Overall, 8 of 10 patients in whom astatic seizures were targeted and treated by anterior and/or posterior SLCC experienced meaningful improvement. SLCC procedures with direct MRI guidance (n = 7) versus a frameless surgical robot (n = 8) yielded median radial accuracies of 1.1 mm (range 0.2-2.0 mm) versus 2.4 mm (range 0.6-6.1 mm; p = 0.0011). The most serious adverse event was a clinically significant intraparenchymal hemorrhage in a patient who underwent the robotic technique. CONCLUSIONS This is the largest reported series of SLCC for epilepsy to date. SLCC provides seizure outcomes comparable to open surgery outcomes reported in the literature. Direct MRI guidance is more accurate, which has the potential to reduce the risks of SLCC. Methodological advancements and larger studies are needed.
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Affiliation(s)
| | | | | | - Amit M Saindane
- 4Radiology, Emory University School of Medicine, Atlanta, Georgia
| | - Deqiang Qiu
- 4Radiology, Emory University School of Medicine, Atlanta, Georgia
| | - Daniel J Curry
- 5Department of Neurosurgery, Texas Children's Hospital, Houston, Texas; and
| | | | - Jon T Willie
- 3Neurosurgery, and
- 6Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri
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29
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Robert SM, Chiang VL. Commentary: Feasibility and Morbidity of Magnetic Resonance Imaging-Guided Stereotactic Laser Ablation of Deep Cerebral Cavernous Malformations: A Report of 4 Cases. Neurosurgery 2021; 89:E209-E210. [PMID: 34293138 DOI: 10.1093/neuros/nyab262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 06/10/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Stephanie M Robert
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Veronica L Chiang
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
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30
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Malcolm JG, Douglas JM, Greven A, Rich C, Dawoud RA, Hu R, Reisner A, Barrow DL, Gross RE, Willie JT. Feasibility and Morbidity of Magnetic Resonance Imaging-Guided Stereotactic Laser Ablation of Deep Cerebral Cavernous Malformations: A Report of 4 Cases. Neurosurgery 2021; 89:635-644. [PMID: 34270738 DOI: 10.1093/neuros/nyab241] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 05/08/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Magnetic resonance imaging (MRI)-guided laser interstitial thermal therapy (MRgLITT) has been used successfully to treat epileptogenic cortical cerebral cavernous malformations (CCM). It is unclear whether MRgLITT would be as feasible or safe for deep CCMs. OBJECTIVE To describe our experience with MRgLITT for symptomatic deep CCMs. METHODS Patients' records were reviewed retrospectively. MRgLITT was carried out using a commercially available system in an interventional MRI suite with efforts to protect adjacent brain structures. Immediate postoperative imaging was used to judge ablation adequacy. Delayed postoperative MRI was used to measure lesion volume changes during follow-up. RESULTS Four patients with CCM in the thalamus, putamen, midbrain, or subthalamus presented with persistent and disabling neurological symptoms. A total of 2 patients presented with disabling headaches and sensory disturbances and 2 with recurrent symptomatic hemorrhages, of which 1 had familial CCM. Patients were considered by vascular neurosurgeons to be poor candidates for open surgery or had refused it. Multiple trajectories were used in most cases. Adverse events included device malfunction with leakage of saline causing transient mass effect in one patient, and asymptomatic tract hemorrhage in another. One patient suffered an expected mild but persistent exacerbation of baseline deficits. All patients showed improvement from a previously aggressive clinical course with lesion volume decreased by 20% to 73% in follow-up. CONCLUSION MRgLITT is feasible in the treatment of symptomatic deep CCM but may carry a high risk of complications without the benefit of definitive resection. We recommend cautious patient selection, low laser power settings, and conservative temperature monitoring in surrounding brain parenchyma.
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Affiliation(s)
- James G Malcolm
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Alex Greven
- Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Reem A Dawoud
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ranliang Hu
- Department of Radiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Andrew Reisner
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA.,Department of Neurosurgery, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Daniel L Barrow
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Robert E Gross
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jon T Willie
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
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31
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Awad IA. Commentary: Feasibility and Morbidity of Magnetic Resonance Imaging-Guided Stereotactic Laser Ablation of Deep Cerebral Cavernous Malformations: A Report of 4 Cases. Neurosurgery 2021; 89:E207-E208. [PMID: 34270760 DOI: 10.1093/neuros/nyab247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 05/23/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Issam A Awad
- Department of Neurological Surgery, University of Chicago Medicine and Biological Sciences, Chicago, Illinois, USA
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32
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Remick M, McDowell MM, Gupta K, Felker J, Abel TJ. Emerging indications for stereotactic laser interstitial thermal therapy in pediatric neurosurgery. Int J Hyperthermia 2021; 37:84-93. [PMID: 32672117 DOI: 10.1080/02656736.2020.1769868] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Surgical treatment of deep or difficult to access lesions represents a unique and significant challenge for pediatric neurosurgeons. The introduction of stereotactic magnetic resonance-guided laser interstitial thermal therapy (LITT) over the last decade has had a dramatic impact on the landscape of pediatric neurosurgery. LITT provides a safe and effective option for children with epilepsy from hypothalamic hamartoma that represents a ground-breaking new therapy for a condition which was historically very difficult to treat with previous neurosurgical techniques. LITT has also been used as an alternative surgical technique for mesial temporal sclerosis, focal cortical dysplasia, MR-negative epilepsy, cavernoma-related epilepsy, insular epilepsy, and corpus callosotomy among other epilepsy etiologies. In some cases, LITT has been associated with improved cognitive outcomes compared to standard techniques, as in mesial temporal lobe epilepsy. Initial experiences with LITT for neuro-oncologic processes are also promising. LITT is often attractive to patients and providers as a minimally invasive approach, but the differences in safety and clinical outcome between LITT and traditional approaches are still being studied. In this review, we examine the emerging indications and clinical evidence for LITT in pediatric neurosurgery.
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Affiliation(s)
- Madison Remick
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michael M McDowell
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kanupriya Gupta
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - James Felker
- Department of Pediatric Neuro-Oncology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Taylor J Abel
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA.,University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
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33
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Seizure outcome in patients with cavernous malformation after early surgery. Epilepsy Behav 2021; 115:107662. [PMID: 33339740 DOI: 10.1016/j.yebeh.2020.107662] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 11/22/2020] [Accepted: 11/23/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To describe seizure outcome and complications in patients with cavernous malformations (CM) undergoing early versus late surgery. METHODS A database was created for all CM patients who presented with seizure referred to the neurosurgical clinic at an academic center. A telephone survey and chart review were conducted to evaluate for preoperative and postoperative seizure frequency. Postoperative seizure-free outcome of patients who had ≤2 preoperative seizures versus those that had >2 preoperative seizures was compared. RESULTS A total of 35 CM patients were included for analysis. Nineteen patients had ≤2 preoperative seizures and 16 patients had >2 preoperative seizures, six of them drug resistant for over two years. Among the ≤2 seizure group, 15 had only a single seizure before surgical resection. 94.7% of patients with ≤2 preoperative seizures and 62.5% of patients with >2 preoperative seizures were seizure free one year following surgical resection (p = 0.019). 78.9% of patients with ≤2 preoperative seizures and 25% of patients with >2 preoperative seizures were able to wean off AEDs (p < 0.001). Among those patients who had a single preoperative seizure, 100% of patients were seizure free at one year. CONCLUSIONS Early surgical resection for CM patients who present after a CM-related seizure is an effective, well tolerated treatment and has good chance to offer seizure freedom without the need for long-term antiepileptic medications. Outcome for patients operated with only one or two preoperative seizures may lead to better results than patients who delay the procedure.
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Gao X, Yue K, Sun J, Cao Y, Zhao B, Zhang H, Dai S, Zhang L, Luo P, Jiang X. Treatment of Cerebral Cavernous Malformations Presenting With Seizures: A Systematic Review and Meta-Analysis. Front Neurol 2020; 11:590589. [PMID: 33193057 PMCID: PMC7649328 DOI: 10.3389/fneur.2020.590589] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 09/25/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Cerebral cavernous malformations (CCMs) presenting with seizures can be treated with neurosurgery or radiosurgery, but the ideal treatment remains unclear. Currently, there is no adequate randomized controlled trial comparing surgical treatment and radiotherapy for epileptogenic CCMs. Therefore, we conducted a systematic review and meta-analysis of available data from published literature to compare the efficacy and safety of neurosurgery and radiosurgery for epileptogenic CCMs. Methods: We performed a comprehensive search of the Ovid MEDLINE, Web of Science, PubMed, China Biological Medicine and China National Knowledge Infrastructure databases for studies published between January 1994 and October 2019. The search terms were as follows: "epilepsy," "seizures," "brain cavernous hemangioma," "cerebral cavernous malformation," "cerebral cavernous hemangioma," "hemangioma, cavernous, central nervous system." Two researchers independently extracted the data and reviewed all the articles. We compared the advantages and disadvantages of the two treatments. Results: A total of 45 studies were included in our analysis. Overall, the seizure control rate was 79% (95% CI: 75-83%) for neurosurgery and 49% (95% CI: 38-59%) for radiosurgery. In the neurosurgery studies, 4.4% of patients experienced permanent morbidity, while no patients in the radiotherapy studies had permanent morbidity. In addition, the results of subgroup analysis showed that ethnicity, CCMs location and average lesion number are likely significant factors influencing the seizure outcome following treatment. Conclusions: The epilepsy control rate after neurosurgery was higher than that after radiosurgery, but neurosurgery also had a relatively higher rate of permanent morbidity.
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Affiliation(s)
- Xiangyu Gao
- Department of Neurosurgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Kangyi Yue
- Department of Neurosurgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Jidong Sun
- Department of Neurosurgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Yuan Cao
- Department of Neurosurgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Boyan Zhao
- Department of Neurosurgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Haofuzi Zhang
- Department of Neurosurgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Shuhui Dai
- Department of Neurosurgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Lei Zhang
- Department of Neurosurgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Peng Luo
- Department of Neurosurgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Xiaofan Jiang
- Department of Neurosurgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
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Katsevman GA, Razzaq B, Serrano CA. Hypothalamic Cavernomas: Pediatric Case Report with 8.5-Year Follow-up and Review of the Literature. World Neurosurg 2020; 146:6-13. [PMID: 33080404 DOI: 10.1016/j.wneu.2020.10.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/11/2020] [Accepted: 10/12/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cavernous malformations (cavernomas) are angiographically occult vascular lesions that can present symptomatically or be discovered incidentally. Rarely, they present in the hypothalamus or in children. CASE DESCRIPTION We describe the case of a 14-year-old male patient who presented with headaches and fever and was found to have a hypothalamic cavernoma that hemorrhaged. It was managed expectantly, with 1 rehemorrhage 21 months later, and the patient remains asymptomatic to this day aside from headaches. CONCLUSIONS This is to our knowledge the youngest case of a hypothalamic cavernoma to be reported and includes 8.5 years of follow-up and imaging. In addition, a literature review is performed that summarizes the 11 previously reported cases of hypothalamic cavernomas, including associated symptoms, management options, and outcomes.
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Affiliation(s)
- Gennadiy A Katsevman
- Department of Neurosurgery, West Virginia University, Morgantown, West Virginia, USA.
| | - Bayan Razzaq
- School of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Cesar A Serrano
- Department of Neurosurgery, West Virginia University, Morgantown, West Virginia, USA
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Youngerman BE, Save AV, McKhann GM. Magnetic Resonance Imaging-Guided Laser Interstitial Thermal Therapy for Epilepsy: Systematic Review of Technique, Indications, and Outcomes. Neurosurgery 2020; 86:E366-E382. [PMID: 31980831 DOI: 10.1093/neuros/nyz556] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 11/20/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND For patients with focal drug-resistant epilepsy (DRE), surgical resection of the epileptogenic zone (EZ) may offer seizure freedom and benefits for quality of life. Yet, concerns remain regarding invasiveness, morbidity, and neurocognitive side effects. Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) has emerged as a less invasive option for stereotactic ablation rather than resection of the EZ. OBJECTIVE To provide an introduction to MRgLITT for epilepsy, including historical development, surgical technique, and role in therapy. METHODS The development of MRgLITT is briefly recounted. A systematic review identified reported techniques and indication-specific outcomes of MRgLITT for DRE in human studies regardless of sample size or follow-up duration. Potential advantages and disadvantages compared to available alternatives for each indication are assessed in an unstructured review. RESULTS Techniques and outcomes are reported for mesial temporal lobe epilepsy, hypothalamic hamartoma, focal cortical dysplasia, nonlesional epilepsy, tuberous sclerosis, periventricular nodular heterotopia, cerebral cavernous malformations, poststroke epilepsy, temporal encephalocele, and corpus callosotomy. CONCLUSION MRgLITT offers access to foci virtually anywhere in the brain with minimal disruption of the overlying cortex and white matter, promising fewer neurological side effects and less surgical morbidity and pain. Compared to other ablative techniques, MRgLITT offers immediate, discrete lesions with real-time monitoring of temperature beyond the fiber tip for damage estimates and off-target injury prevention. Applications of MRgLITT for epilepsy are growing rapidly and, although more evidence of safety and efficacy is needed, there are potential advantages for some patients.
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Affiliation(s)
- Brett E Youngerman
- Department of Neurological Surgery, Columbia University Medical Center, New York, New York
| | - Akshay V Save
- Department of Neurological Surgery, Columbia University Medical Center, New York, New York
| | - Guy M McKhann
- Department of Neurological Surgery, Columbia University Medical Center, New York, New York
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Wang Y, Xu J, Liu T, Chen F, Chen S, Xie Z, Fang T, Liang S. Magnetic resonance–guided laser interstitial thermal therapy versus stereoelectroencephalography-guided radiofrequency thermocoagulation for drug-resistant epilepsy: A systematic review and meta-analysis. Epilepsy Res 2020; 166:106397. [DOI: 10.1016/j.eplepsyres.2020.106397] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 06/09/2020] [Accepted: 06/10/2020] [Indexed: 11/30/2022]
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Gupta K, Cabaniss B, Kheder A, Gedela S, Koch P, Hewitt KC, Alwaki A, Rich C, Ramesha S, Hu R, Drane DL, Gross RE, Willie JT. Stereotactic MRI-guided laser interstitial thermal therapy for extratemporal lobe epilepsy. Epilepsia 2020; 61:1723-1734. [PMID: 32777090 DOI: 10.1111/epi.16614] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 06/24/2020] [Accepted: 06/24/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Magnetic resonance imaging (MRI)-guided laser interstitial thermal therapy (MRg-LITT) is an alternative to open epilepsy surgery. We assess safety and effectiveness of MRg-LITT for extratemporal lobe epilepsy (ETLE) in patients who are considered less favorable for open resection. METHODS We retrospectively reviewed sequential cases of patients with focal ETLE who underwent MRg-LITT between 2012 and 2019. Epileptogenic zones were determined from standard clinical and imaging data ± stereoelectroencephalography (SEEG). Standard stereotactic techniques, MRI thermometry, and a commercial laser thermal therapy system were used for ablations. Anatomic MRI was used to calculate ablation volumes. Clinical outcomes were determined longitudinally. RESULTS Thirty-five patients with mean epilepsy duration of 21.3 ± 12.2 years underwent MRg-LITT for focal ETLE at a mean age 36.4 ± 12.7 years. A mean 2.59 ± 1.45 trajectories per patient were used to obtain ablation volumes of 8.8 ± 7.5 cm3 . Mean follow-up was 27.3 ± 19.5 months. Of 32 patients with >12 months of follow-up, 17 (53%) achieved good outcomes (Engel class I + II) of whom 14 (44%) were Engel class I. Subgroup analysis revealed better outcomes for patients with lesional ETLE than for those who were nonlesional, multifocal, or who had failed prior interventions (P = .02). Of 13 patients showing favorable seizure-onset patterns (localized low voltage fast activity or rhythmic spiking on SEEG) prior to ablation, 9 (69%) achieved good outcomes, whereas only 3 of 11 (27%) who show other slower onset patterns achieved good outcomes. Minor adverse events included six patients with transient sensorimotor neurologic deficits and four patients with asymptomatic hemorrhages along the fiber tract. Major adverse events included one patient with a brain abscess that required stereotactic drainage and one patient with persistent hypothalamic obesity. Three deaths-two seizure-associated and one suicide-were unrelated to surgical procedures. SIGNIFICANCE MRI-guided laser interstitial thermal therapy (or MRg-LITT) was well-tolerated and yielded good outcomes in a heterogeneous group of ETLE patients. Lesional epilepsy and favorable seizure-onset patterns on SEEG predicted higher likelihoods of success.
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Affiliation(s)
- Kunal Gupta
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Brian Cabaniss
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ammar Kheder
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Satyanarayana Gedela
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Paul Koch
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kelsey C Hewitt
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Abdulrahman Alwaki
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Christopher Rich
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Supriya Ramesha
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ranliang Hu
- Department of Radiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Daniel L Drane
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA.,Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA.,Department of Neurology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Robert E Gross
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jon T Willie
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
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Gamboa NT, Karsy M, Iyer RR, Bollo RJ, Schmidt RH. Stereotactic laser interstitial thermal therapy for brainstem cavernous malformations: two preliminary cases. Acta Neurochir (Wien) 2020; 162:1771-1775. [PMID: 32281027 DOI: 10.1007/s00701-020-04316-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 03/29/2020] [Indexed: 11/28/2022]
Abstract
Brainstem cavernous malformations (CMs) often have high hemorrhage rates and significant posthemorrhage morbidity. The authors present two cases in which magnetic resonance thermography-guided laser interstitial therapy was used for treatment of pontine CMs after recurrent hemorrhage. Both patients showed significant symptomatic improvement and were hemorrhage-free at 12- and 6-month follow-up, respectively. Each had radiographic evidence of lesion involution on serial follow-up imaging. These early results demonstrate this treatment modality may be technically safe; however, larger case numbers and longer follow-up are needed to demonstrate efficacy.
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Affiliation(s)
- Nicholas T Gamboa
- Department of Neurosurgery, Clinical Neurosciences Center, 175 North Medical Drive East, Salt Lake City, UT, 84132, USA
| | - Michael Karsy
- Department of Neurosurgery, Clinical Neurosciences Center, 175 North Medical Drive East, Salt Lake City, UT, 84132, USA.
| | - Rajiv R Iyer
- Department of Neurosurgery, Clinical Neurosciences Center, 175 North Medical Drive East, Salt Lake City, UT, 84132, USA
- Division of Pediatric Neurosurgery, Primary Children's Hospital, University of Utah, Salt Lake City, UT, USA
| | - Robert J Bollo
- Department of Neurosurgery, Clinical Neurosciences Center, 175 North Medical Drive East, Salt Lake City, UT, 84132, USA
- Division of Pediatric Neurosurgery, Primary Children's Hospital, University of Utah, Salt Lake City, UT, USA
| | - Richard H Schmidt
- Department of Neurosurgery, Clinical Neurosciences Center, 175 North Medical Drive East, Salt Lake City, UT, 84132, USA
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Multiple Large-Size Cystic Cerebral Cavernomas. World Neurosurg 2020; 139:410-414. [PMID: 32376377 DOI: 10.1016/j.wneu.2020.04.189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 04/23/2020] [Accepted: 04/24/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Cerebral cavernomas are vascular malformations characterized by networks of abnormally dilated capillaries. They typically present as nodules with mixed signal intensity and a surrounding hemosiderin rim on magnetic resonance imaging. They may occur as multiple lesions in the autosomal-dominant familial form. In rare cases, cavernomas may form cystic masses, mimicking other pathologies. CASE DESCRIPTION A 35-year-old man presented with recurrent seizures, aphasia, and gait disturbance with onset at age 14 years. He had previously undergone surgical drainage of multiple cysts across the brain with suspected parasitic infection. On magnetic resonance imaging, 22 cystic lesions were seen across the brain. A large cyst was located in the midline cerebellum, compressing the fourth ventricle. Occipital craniotomy and transvermian dissection allowed total resection of the cyst along with its wall. The postoperative course was uneventful and symptoms progressively improved. Histological analysis revealed cavernoma. Three more surgeries were performed for removal of large supratentorial cavernomas. CONCLUSIONS In patients with cystic lesions of the brain, the neurosurgeon should consider the possibility of cavernoma. Total excision along with the cyst wall is crucial for timely diagnosis and therapy.
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Dorfer C, Rydenhag B, Baltuch G, Buch V, Blount J, Bollo R, Gerrard J, Nilsson D, Roessler K, Rutka J, Sharan A, Spencer D, Cukiert A. How technology is driving the landscape of epilepsy surgery. Epilepsia 2020; 61:841-855. [PMID: 32227349 PMCID: PMC7317716 DOI: 10.1111/epi.16489] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 03/03/2020] [Accepted: 03/04/2020] [Indexed: 12/24/2022]
Abstract
This article emphasizes the role of the technological progress in changing the landscape of epilepsy surgery and provides a critical appraisal of robotic applications, laser interstitial thermal therapy, intraoperative imaging, wireless recording, new neuromodulation techniques, and high-intensity focused ultrasound. Specifically, (a) it relativizes the current hype in using robots for stereo-electroencephalography (SEEG) to increase the accuracy of depth electrode placement and save operating time; (b) discusses the drawback of laser interstitial thermal therapy (LITT) when it comes to the need for adequate histopathologic specimen and the fact that the concept of stereotactic disconnection is not new; (c) addresses the ratio between the benefits and expenditure of using intraoperative magnetic resonance imaging (MRI), that is, the high technical and personnel expertise needed that might restrict its use to centers with a high case load, including those unrelated to epilepsy; (d) soberly reviews the advantages, disadvantages, and future potentials of neuromodulation techniques with special emphasis on the differences between closed and open-loop systems; and (e) provides a critical outlook on the clinical implications of focused ultrasound, wireless recording, and multipurpose electrodes that are already on the horizon. This outlook shows that although current ultrasonic systems do have some limitations in delivering the acoustic energy, further advance of this technique may lead to novel treatment paradigms. Furthermore, it highlights that new data streams from multipurpose electrodes and wireless transmission of intracranial recordings will become available soon once some critical developments will be achieved such as electrode fidelity, data processing and storage, heat conduction as well as rechargeable technology. A better understanding of modern epilepsy surgery will help to demystify epilepsy surgery for the patients and the treating physicians and thereby reduce the surgical treatment gap.
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Affiliation(s)
- Christian Dorfer
- Department of NeurosurgeryMedical University of ViennaViennaAustria
| | - Bertil Rydenhag
- Department of Clinical NeuroscienceInstitute of Neuroscience and PhysiologyThe Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
- Department of NeurosurgerySahlgrenska University HospitalGothenburgSweden
| | - Gordon Baltuch
- Center for Functional and Restorative NeurosurgeryUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - Vivek Buch
- Center for Functional and Restorative NeurosurgeryUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - Jeffrey Blount
- Division of NeurosurgeryUniversity of Alabama at Birmingham School of MedicineBirminghamALUSA
| | - Robert Bollo
- Department of NeurosurgeryUniversity of Utah School of MedicineSalt Lake CityUTUSA
| | - Jason Gerrard
- Department of NeurosurgeryYale University School of MedicineNew HavenCTUSA
| | - Daniel Nilsson
- Department of Clinical NeuroscienceInstitute of Neuroscience and PhysiologyThe Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
- Department of NeurosurgerySahlgrenska University HospitalGothenburgSweden
| | - Karl Roessler
- Department of NeurosurgeryMedical University of ViennaViennaAustria
- Department of NeurosurgeryUniversity of ErlangenErlangenGermany
| | - James Rutka
- Division of Pediatric NeurosurgeryThe Hospital for Sick ChildrenUniversity of TorontoTorontoOntarioCanada
| | - Ashwini Sharan
- Department of Neurosurgery and NeurologyThomas Jefferson UniversityPhiladelphiaPAUSA
| | - Dennis Spencer
- Department of NeurosurgeryYale University School of MedicineNew HavenCTUSA
| | - Arthur Cukiert
- Neurology and Neurosurgery Clinic Sao PauloClinica Neurologica CukiertSao PauloBrazil
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Satzer D, Tao JX, Issa NP, Chen Z, Wu S, Rose S, Collins J, Awad IA, Warnke PC. Stereotactic laser interstitial thermal therapy for epilepsy associated with solitary and multiple cerebral cavernous malformations. Neurosurg Focus 2020; 48:E12. [DOI: 10.3171/2020.1.focus19866] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 01/27/2020] [Indexed: 11/06/2022]
Abstract
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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Affiliation(s)
| | | | | | - Ziyi Chen
- 4Department of Neurology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China
| | | | | | - John Collins
- 3Radiology, University of Chicago, Illinois; and
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Kokuryo D, Kumamoto E, Kuroda K. Recent technological advancements in thermometry. Adv Drug Deliv Rev 2020; 163-164:19-39. [PMID: 33217482 DOI: 10.1016/j.addr.2020.11.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 07/25/2020] [Accepted: 11/02/2020] [Indexed: 12/12/2022]
Abstract
Thermometry is the key factor for achieving successful thermal therapy. Although invasive thermometry with a probe has been used for more than four decades, this method can only detect the local temperature within the probing volume. Noninvasive temperature imaging using a tomographic technique is ideal for monitoring hot-spot formation in the human body. Among various techniques, such as X-ray computed tomography, microwave tomography, echo sonography, and magnetic resonance (MR) imaging, the proton resonance frequency shift method of MR thermometry is the only method currently available for clinical practice because its temperature sensitivity is consistent in most aqueous tissues and can be easily observed using common clinical scanners. New techniques are being proposed to improve the robustness of this method against tissue motion. MR techniques for fat thermometry were also developed based on relaxation times. One of the latest non-MR techniques to attract attention is photoacoustic imaging.
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Affiliation(s)
- Daisuke Kokuryo
- Graduate School of System Informatics, Kobe University, Japan
| | - Etsuko Kumamoto
- Information Science and Technology Center, Kobe University, Japan
| | - Kagayaki Kuroda
- School of Information Science and Technology, Tokai University, Japan; Center for Frontier Medical Engineering, Chiba University, Japan.
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Rosenow F, Hattingen E, Wagner M, Freiman TM, Konczalla J, Knake S, Strzelczyk A. Susceptibility‐weighted imaging (
SWI
) or T2* contrasts should remain standard in the neuroimaging of epilepsy. Epilepsia 2019; 60:2141-2142. [DOI: 10.1111/epi.16323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 06/25/2019] [Accepted: 06/25/2019] [Indexed: 01/27/2023]
Affiliation(s)
- Felix Rosenow
- Epilepsy Center Frankfurt Rhine‐Main Department of Neurology Goethe‐University Frankfurt Frankfurt am Main Germany
| | - Elke Hattingen
- Institute of Neuroradiology Goethe-University Frankfurt Frankfurt am Main Germany
| | - Marlies Wagner
- Institute of Neuroradiology Goethe-University Frankfurt Frankfurt am Main Germany
| | - Thomas M. Freiman
- Department of Neurosurgery Goethe-University Frankfurt Frankfurt am Main Germany
| | - Jürgen Konczalla
- Department of Neurosurgery Goethe-University Frankfurt Frankfurt am Main Germany
| | - Susanne Knake
- Epilepsy Center Hessen Department of Neurology Philipps‐University Marburg Marburg Germany
| | - Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine‐Main Department of Neurology Goethe‐University Frankfurt Frankfurt am Main Germany
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45
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Awad IA, Polster SP. Cavernous angiomas: deconstructing a neurosurgical disease. J Neurosurg 2019; 131:1-13. [PMID: 31261134 PMCID: PMC6778695 DOI: 10.3171/2019.3.jns181724] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 03/15/2019] [Indexed: 01/08/2023]
Abstract
Cavernous angioma (CA) is also known as cavernoma, cavernous hemangioma, and cerebral cavernous malformation (CCM) (National Library of Medicine Medical Subject heading unique ID D006392). In its sporadic form, CA occurs as a solitary hemorrhagic vascular lesion or as clustered lesions associated with a developmental venous anomaly. In its autosomal dominant familial form (Online Mendelian Inheritance in Man #116860), CA is caused by a heterozygous germline loss-of-function mutation in one of three genes-CCM1/KRIT1, CCM2/Malcavernin, and CCM3/PDCD10-causing multifocal lesions throughout the brain and spinal cord.In this paper, the authors review the cardinal features of CA's disease pathology and clinical radiological features. They summarize key aspects of CA's natural history and broad elements of evidence-based management guidelines, including surgery. The authors also discuss evidence of similar genetic defects in sporadic and familial lesions, consequences of CCM gene loss in different tissues at various stages of development, and implications regarding the pathobiology of CAs.The concept of CA with symptomatic hemorrhage (CASH) is presented as well as its relevance to clinical care and research in the field. Pathobiological mechanisms related to CA include inflammation and immune-mediated processes, angiogenesis and vascular permeability, microbiome driven factors, and lesional anticoagulant domains. These mechanisms have motivated the development of imaging and plasma biomarkers of relevant disease behavior and promising therapeutic targets.The spectrum of discoveries about CA and their implications endorse CA as a paradigm for deconstructing a neurosurgical disease.
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