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Lu VM, Wang S, Ragheb JR. Impact of Previous Surgery on Success of Magnetic Resonance-guided Laser Interstitial Thermal Therapy (MRgLITT) to Treat Pediatric Epilepsy: An Institutional Experience. World Neurosurg 2024; 186:e707-e712. [PMID: 38616023 DOI: 10.1016/j.wneu.2024.04.037] [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: 01/22/2024] [Revised: 04/05/2024] [Accepted: 04/06/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND There is an emerging role for minimally invasive magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) in the treatment of pediatric epilepsy refractory to medication. To date, predictors of MRgLITT success have not been established in a sizeable singular experience. Correspondingly, the aim of this study was to elucidate if previous surgical history predicts MRgLITT success in this setting. METHODS A retrospective review was conducted of our MRgLITT procedures for pediatric (patient age <19 years) epilepsy from 2011 to 2020 with documented seizure outcomes at 1 and 2 years after procedure. Categorical and continuous data were compared using χ2 and Student's t test, respectively. RESULTS A total of 41 patients satisfied all criteria with 16 (39%) female and 25 (61%) male patients. Following MRgLITT, seizure-freedom at 1-year was achieved in 15 (37%) patients. In the cohort, there were 14 (34%) patients who had undergone previous open surgery for epilepsy at mean age of 9.4 ± 5.5 years. Patients with a previous open surgery history were found to statistically experience longer length of hospitalization after MRgLITT (P = 0.04) with a statistically lower proportion of seizure-freedom at 1-year after MRgLITT (14% vs. 48%, P = 0.03). However, there was no difference in the rate of seizure-freedom at 2 years (29% vs. 41%, P = 0.44), as well as no difference in subsequent surgical interventions for seizure management between groups. CONCLUSIONS Based on our institutional experience, patients with previous open surgery history may experience longer length of hospitalization after MRgLITT for pediatric epilepsy and lesser response in seizure-freedom within the first year but with non-inferior seizure freedom by the second year.
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Affiliation(s)
- Victor M Lu
- Department of Neurological Surgery, University of Miami, Jackson Memorial Hospital, Miami, Florida, USA; Department of Neurological Surgery, Nicklaus Children's Hospital, Miami, Florida, USA.
| | - Shelly Wang
- Department of Neurological Surgery, University of Miami, Jackson Memorial Hospital, Miami, Florida, USA; Department of Neurological Surgery, Nicklaus Children's Hospital, Miami, Florida, USA
| | - John R Ragheb
- Department of Neurological Surgery, University of Miami, Jackson Memorial Hospital, Miami, Florida, USA; Department of Neurological Surgery, Nicklaus Children's Hospital, Miami, Florida, USA
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Al-Ramadhani R, Hect JL, Abel TJ. The changing landscape of palliative epilepsy surgery for Lennox Gastaut Syndrome. Front Neurol 2024; 15:1380423. [PMID: 38515452 PMCID: PMC10954786 DOI: 10.3389/fneur.2024.1380423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 02/21/2024] [Indexed: 03/23/2024] Open
Abstract
Lennox Gastaut Syndrome (LGS) is characterized by drug-resistant epilepsy that typically leads to decreased quality of life and deleterious neurodevelopmental comorbidities from medically refractory seizures. In recent years there has been a dramatic increase in the development and availability of novel treatment strategies for Lennox Gastaut Syndrome patient to improve seizure. Recent advances in neuromodulation and minimally invasive magnetic resonance guided laser interstitial thermal therapy (MRgLITT) have paved the way for new treatments strategies including deep brain stimulation (DBS), responsive neurostimulation (RNS), and MRgLITT corpus callosum ablation. These new strategies offer hope for children with drug-resistant generalized epilepsies, but important questions remain about the safety and effectiveness of these new approaches. In this review, we describe the opportunities presented by these new strategies and how each treatment strategy is currently being employed. Next, we will critically assess available evidence for these new approaches compared to traditional palliative epilepsy surgery approaches, such as vagus nerve stimulation (VNS) and open microsurgical corpus callosotomy (CC). Finally, we will describe future directions that would help define which of the available strategies should be employed and when.
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Affiliation(s)
- Ruba Al-Ramadhani
- Department of Pediatrics, Division of Child Neurology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Jasmine L. Hect
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Taylor J. Abel
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, United States
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States
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Hansen D, Shandley S, Olaya J, Hauptman J, Auguste K, Ostendorf AP, Depositario-Cabacar DF, Wong-Kisiel LC, Reddy SB, McCormack MJ, Gonzalez-Giraldo E, Sullivan J, Pradeep J, Singh RK, Romanowski EF, McNamara NA, Ciliberto MA, Tatachar P, Shrey DW, Karakas C, Karia S, Kheder A, Gedela S, Alexander A, Eschbach K, Bolton J, Marashly A, Wolf S, McGoldrick P, Nangia S, Grinspan Z, Coryell J, Samanta D, Armstrong D, Perry MS. A multi-center comparison of surgical techniques for corpus Callosotomy in pediatric drug-resistant epilepsy. Epilepsia 2024; 65:422-429. [PMID: 38062633 DOI: 10.1111/epi.17853] [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: 07/11/2023] [Revised: 12/05/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVES Corpus callosotomy (CC) is used to reduce seizures, primarily in patients with generalized drug-resistant epilepsy (DRE). The invasive nature of the procedure contributes to underutilization despite its potential superiority to other palliative procedures. The goal of this study was to use a multi-institutional epilepsy surgery database to characterize the use of CC across participating centers. METHODS Data were acquired from the Pediatric Epilepsy Research Consortium (PERC) Surgery Database, a prospective observational study collecting data on children 0-18 years referred for surgical evaluation of DRE across 22 U.S. pediatric epilepsy centers. Patient, epilepsy, and surgical characteristics were collected across multiple CC modalities. Outcomes and complications were recorded and analyzed statistically. RESULTS Eighty-three patients undergoing 85 CC procedures at 14 participating epilepsy centers met inclusion criteria. Mean age at seizure onset was 2.3 years (0-9.4); mean age for Phase I evaluation and surgical intervention were 9.45 (.1-20) and 10.46 (.2-20.6) years, respectively. Generalized seizure types were the most common (59%). Complete CC was performed in 88%. The majority of CC procedures (57%) were via open craniotomy, followed by laser interstitial thermal therapy (LiTT) (20%) and mini-craniotomy/endoscopic (mc/e) (22%). Mean operative times were significantly longer for LiTT, whereas mean estimated blood loss was greater in open cases. Complications occurred in 11 cases (13%) and differed significantly between surgical techniques (p < .001). There was no statistically significant difference in length of postoperative stay across approaches. Mean follow-up was 12.8 months (range 1-39). Favorable Engel outcomes were experienced by 37 (78.7%) of the patients who underwent craniotomy, 10 (58.8%) with LiTT, and 12 (63.2%) with mc/e; these differences were not statistically significant. SIGNIFICANCE CC is an effective surgical modality for children with DRE. Regardless of surgical modality, complication rates are acceptable and seizure outcomes generally favorable. Newer, less-invasive, surgical approaches may lead to increased adoption of this efficacious therapeutic option for pediatric DRE.
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Affiliation(s)
- Daniel Hansen
- Jane and John Justin Institute for Mind Health, Cook Children's Medical Center, Fort Worth, Texas, USA
| | - Sabrina Shandley
- Jane and John Justin Institute for Mind Health, Cook Children's Medical Center, Fort Worth, Texas, USA
| | - Joffre Olaya
- Children's Hospital of Orange County, Orange, California, USA
| | - Jason Hauptman
- Division of Pediatric Neurosurgery, University of Washington/Seattle Children's Hospital, Seattle, Washington, USA
| | - Kurtis Auguste
- University of California San Francisco Weill Institute for Neurosciences, Benioff Children's Hospital, San Francisco, California, USA
| | - Adam P Ostendorf
- Department of Pediatrics, Nationwide Children's Hospital, Ohio State University, Columbus, Ohio, USA
| | - Dewi F Depositario-Cabacar
- Center for Neuroscience, Children's National Hospital, George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Lily C Wong-Kisiel
- Department of Neurology, Divisions of Child Neurology and Epilepsy, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Shilpa B Reddy
- Department of Pediatric Neurology, Vanderbilt University, Monroe Carell Jr Children's Hospital, Nashville, Tennessee, USA
| | - Michael J McCormack
- Department of Pediatric Neurology, Vanderbilt University, Monroe Carell Jr Children's Hospital, Nashville, Tennessee, USA
| | - Ernesto Gonzalez-Giraldo
- University of California San Francisco Weill Institute for Neurosciences, Benioff Children's Hospital, San Francisco, California, USA
| | - Joseph Sullivan
- University of California San Francisco Weill Institute for Neurosciences, Benioff Children's Hospital, San Francisco, California, USA
| | - Javarayee Pradeep
- Department of Pediatric Neurology, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Rani K Singh
- Division of Neurology, Department of Pediatrics, Atrium Health/Levine Children's Hospital, Charlotte, North Carolina, USA
| | - Erin Fedak Romanowski
- Department of Pediatrics, Division of Pediatric Neurology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Nancy A McNamara
- Department of Pediatrics, Division of Pediatric Neurology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Michael A Ciliberto
- Department of Pediatrics, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Priya Tatachar
- Department of Pediatrics, Ann and Robert H Lurie Children's Hospital, Chicago, Illinois, USA
| | - Daniel W Shrey
- Children's Hospital of Orange County, Orange, California, USA
| | - Cemal Karakas
- Department of Neurology, Norton Children's Hospital, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Samir Karia
- Department of Neurology, Norton Children's Hospital, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Ammar Kheder
- Department of Pediatrics, Emory University College of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Satyanarayana Gedela
- Department of Pediatrics, Emory University College of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Allyson Alexander
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Division of Pediatric Neurosurgery, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Krista Eschbach
- Department of Neurology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Jeffrey Bolton
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Ahmad Marashly
- Department of Neurology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Steven Wolf
- Boston Children's Health Physicians of New York and Connecticut, Maria Fareri Children's Hospital, New York Medical College, Valhalla, New York, USA
| | - Patricia McGoldrick
- Boston Children's Health Physicians of New York and Connecticut, Maria Fareri Children's Hospital, New York Medical College, Valhalla, New York, USA
| | | | | | - Jason Coryell
- Doernbecher Children's Hospital, Oregon Health and Sciences University, Oregon Health Science Center, Portland, Oregon, USA
| | - Debopam Samanta
- Department of Neurology, Arkansas Children's Hospital, Little Rock, Arkansas, USA
| | - Dallas Armstrong
- Department of Neurology, University of Texas Southwestern, Dallas, Texas, USA
| | - M Scott Perry
- Jane and John Justin Institute for Mind Health, Cook Children's Medical Center, Fort Worth, Texas, USA
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Alomar SA, Moshref RH, Moshref LH, Sabbagh AJ. Outcomes after laser interstitial thermal ablation for temporal lobe epilepsy: a systematic review and meta-analysis. Neurosurg Rev 2023; 46:261. [PMID: 37779130 DOI: 10.1007/s10143-023-02164-4] [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: 09/18/2022] [Revised: 08/01/2023] [Accepted: 09/23/2023] [Indexed: 10/03/2023]
Abstract
Epilepsy is a common condition that affects approximately 1% of the world's population, with about one-third being refractory epilepsy. Temporal lobe epilepsy is the most common type of drug-resistant epilepsy, and laser interstitial thermal therapy (LITT) is an innovative treatment. In this systematic review and meta-analysis, we aimed to summarize the current evidence on outcomes after LITT, including seizure freedom rate, complication rate, and neurocognitive outcome. PubMed and OVID Medline search engines were systematically searched for all indexed publications in the English language up to July15, 2023. The search was limited to human studies. Proportions and 95% confidence interval (CI) values were calculated for seizure, neurocognitive outcome, and complication rate. A total of 836 patients were included. Overall seizure outcomes, regardless of the pathology, included Engel I outcome in 56% (95% CI, 52.4-59.5%), Engel II outcome in 19.2% (95% CI, 15.4-23.6%), Engel III outcome in 17.3% (95% CI, 13.5-21.8%), and Engel IV outcome in 10.5% (95% CI 6.3-17%) of the patients. The overall decline in verbal and visual memory regardless of laterality was 24.2 (95% CI 8.6-52%) and 25.2% (8.3-55.8%). For naming, the decline was 13.4% (6.6-25.4%). The results of the pooled analysis in comparison with available data in the literature showed that seizure outcomes after LITT were slightly inferior to published data after temporal lobectomy. Data on cognitive outcomes after LITT are scarce and heterogeneous.
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Affiliation(s)
- Soha A Alomar
- Department of Surgery, Division of Neurosurgery, Faculty of Medicine, King Abdulaziz University, 22254, Jeddah, Saudi Arabia.
| | - Rana H Moshref
- Department of Surgery, Division of Neurosurgery, Faculty of Medicine, King Abdulaziz University, 22254, Jeddah, Saudi Arabia
| | - Leena H Moshref
- Department of Surgery, Division of Neurosurgery, Faculty of Medicine, King Abdulaziz University, 22254, Jeddah, Saudi Arabia
| | - Abdulrahman J Sabbagh
- Department of Surgery, Division of Neurosurgery, Faculty of Medicine, King Abdulaziz University, 22254, Jeddah, Saudi Arabia
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