Curative laser thermoablation of epilepsy secondary to bottom-of-sulcus dysplasia near eloquent cortex

Devine, Irisa M.; Burrell, Christian; Shih, Jerry J.

doi:10.1016/j.seizure.2015.11.006

Cited by 17 publications

(9 citation statements)

References 4 publications

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“…Several clinical studies evaluating LiTT have been published over the past years. Most of them reported the seizure outcome following LiTT in patients with MTLE . Although the seizure‐free rate varied across the series, the results following LiTT might be close to those reported in patients who undergo selective hippocampo‐amygdalectomy .…”

Section: Discussionmentioning

confidence: 70%

“…These data suggest that LiTT might be superior to RF‐TC for this indication. Some studies have also reported encouraging results of LiTT in other types of epilepsies, especially in patients with PNH and focal cortical dysplasia . In these patients, a greater lesion volume is possible with LiTT, which may be associated with better seizure outcome than RF‐TC; however, this remains to be investigated.…”

Section: Discussionmentioning

confidence: 99%

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Stereo‐electroencephalography‐guided radiofrequency thermocoagulation in patients with focal epilepsy: A systematic review and meta‐analysis

et al. 2018

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Objective: Despite the increasing number of studies reporting results of stereo-electroencephalography (SEEG)-guided radiofrequency-thermocoagulation (SEEGguided RF-TC) in the treatment of patients with drug-resistant focal epilepsy, the exact efficacy of this approach remains unclear. The seizure-freedom rate varies greatly across studies and the factors associated with efficacy have not been formally investigated. Methods: All prospective or retrospective studies reporting efficacy and/or safety of SEEG-guided RF-TC in patients with drug-resistant focal epilepsy were included. The primary outcome was the seizure-free rate 1 year after the procedure. Secondary outcomes were (1) the responder rate 1 year after the procedure and (2) the proportion of patients with permanent neurologic deficit 1 year after the procedure. Each outcome was assessed in all patients and in 4 groups of patients defined by the etiology of epilepsy. Each outcome was pooled using inverse variance weighting, logit transformation of proportion, and a randomeffects model. Results: No prospective study was identified and a total of 6 retrospective studies, reporting efficacy and safety data of 296 patients, were included. The pooled rate of permanent neurologic deficit was 2.5% (95% confidence interval [CI] 1.2%-5.3%), without heterogeneity across studies. In contrast, both the seizure-free and responder rates varied greatly across studies, and statistical heterogeneity was high. The pooled seizure-free and responder rates were 23% (95% CI 8%-50%) and 58% (95% CI 36%-77%), respectively. Both for the seizure-free and responder rates, the greatest efficacy was observed in patients with periventricular nodular heterotopia and the lowest in patients with normal magnetic resonance imaging (MRI) findings. Significance: SEEG-guided RF-TC is a safe procedure with low risk of complications. In contrast, the level of evidence regarding its efficacy remains low. Better identification of factors associated with seizure outcome are needed. K E Y W O R D Sintracranial, neurosurgery, RF-TC, SEEG-guided, stereotactic, thermo-SEEG

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Section: Discussionmentioning

confidence: 70%

Section: Discussionmentioning

confidence: 99%

Stereo‐electroencephalography‐guided radiofrequency thermocoagulation in patients with focal epilepsy: A systematic review and meta‐analysis

et al. 2018

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“…With regard to epilepsy surgery, LiTT promises to be particularly feasible for the following indications (sorted in descending order according to number of publications): mesial temporal lobe epilepsy (mTLE), e.g. selective amygdalohippocampectomy (SAH) [5,8,[57][58][59][60][61][62][63][64][65][66][67][68][69], hypothalamic hamartoma (HH) [37,46,[70][71][72][73][74], complex and deep focal cortical dysplasias (FCD), including double cortex [54,[75][76][77], nodular periventricual heterotopias (NPVH) [78,79], tuberous sclerosis (TS) and subependymal giant cell astrocytoma [80], cavernoma/cavernous malformation (including surrounding hemosiderin ring) [81].…”

Section: Indicationsmentioning

confidence: 99%

“…Postoperatively treating the patient with dexamethasone for a few days in order to prevent brain edema seems to be standard practice [5,54]. In several group studies and case reports, no complications were cited [35,42,48,76,81,90]. Several studies reported an absence of otherwise severe, frequently occurring complications (e.g.…”

Section: Complicationsmentioning

confidence: 99%

Laser interstitial thermotherapy (LiTT) in epilepsy surgery

Hoppe

Witt

Helmstaedter

et al. 2017

Seizure

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Besides other innovative stereotactic procedures (radiofrequency thermocoagulation, focused ultrasound, gamma knife) laser interstitial thermotherapy (LiTT) provides minimally invasive destruction of pathological soft tissues which could be especially relevant for epilepsy surgeries involving adult and pediatric patients. Unlike standard resections, no craniotomy is required; just a tiny borehole trepanation is sufficient. Damage to cortical areas when accessing deep lesions can be minimized or completely avoided, and treating epileptogenic foci near eloquent or even vital brain areas becomes possible. Here, we briefly describe the history and rationale of laser neurosurgery as well as the technical key features of the two currently available systems for magnetic resonance-guided LiTT (Visualase, NeuroBlate; CE marks pending for both). We also discuss the published clinical experience with LiTT in the field of epilepsy surgery (approximately 200 cases) with regard to complications, LiTT-induced, long-term brain structural alterations, seizure outcome, preliminary neuropsychological findings and first estimates of treatment costs. Overall, the seizure outcome appears to be slightly worse than for resective surgery. Due to insufficient research methods (e.g. non-established measures, lack of a control condition), the expected neuropsychological superiority over resective surgery has not been unambiguously demonstrated thus far. Also, the cost-benefit ratio requires further critical evaluation. Clinical, multi-center and adequately controlled outcome studies of high quality should also accompany the imminent introduction of LiTT into the field of epilepsy surgery and therewith permit critical scientific evaluation and rational, individual, clinical decisions.

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“…There are only a few reports on using SLA for lesional, extratemporal epilepsy. Pathologies include periventricular nodular heterotopia, 11,29 focal cortical dysplasia, 3,6,11,23 tuberous sclerosis, 5 cavernous malformations, 24 and encephalomalacia. 19 Reports on treating nonlesional extratemporal epilepsy with SLA are mostly restricted to insular epilepsy.…”

Section: Discussionmentioning

confidence: 99%

Stereotactic laser ablation for nonlesional cingulate epilepsy: case report

Marashly¹,

Loman

Lew

2018

Journal of Neurosurgery: Pediatrics

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Stereotactic laser ablation (SLA) is being increasingly used to treat refractory focal epilepsy, especially mesial temporal lobe epilepsy. However, emerging evidence suggests it can be used for extratemporal lobe epilepsy as well.The authors report the case of a 17-year-old male who presented with refractory nocturnal seizures characterized by bilateral arms stiffening or rhythmic jerking lasting several seconds. Semiology suggested an epileptogenic zone close to one of the supplementary sensory motor areas. Electroencephalography showed seizures arising from the central region without consistent lateralization. Brain imaging showed no abnormality. An invasive evaluation using bilateral stereoelectroencephalography (SEEG) was utilized in 2 steps, first to establish the laterality of seizures, and second to further cover the mesial cingulate region of the right hemisphere. Seizures arose from the middle portion of the right cingulate gyrus. Extraoperative electrical mapping revealed that the seizure onset zone was adjacent to eloquent motor areas. SLA targeting the right midcingulate gyrus was performed. The patient has remained seizure free since immediately after the procedure with no postoperative deficits (follow-up of 17 months).This case highlights the utility of SEEG in evaluating difficult-to-localize, focal epilepsy. It also demonstrates that the use of SLA can be extended to nonlesional, extratemporal epilepsies.

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Curative laser thermoablation of epilepsy secondary to bottom-of-sulcus dysplasia near eloquent cortex

Cited by 17 publications

References 4 publications

Stereo‐electroencephalography‐guided radiofrequency thermocoagulation in patients with focal epilepsy: A systematic review and meta‐analysis

Stereo‐electroencephalography‐guided radiofrequency thermocoagulation in patients with focal epilepsy: A systematic review and meta‐analysis

Laser interstitial thermotherapy (LiTT) in epilepsy surgery

Stereotactic laser ablation for nonlesional cingulate epilepsy: case report

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