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

Abstract

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

Minimally Invasive Destructive, Ablative, and Disconnective Epilepsy Surgery

“…Although, sEEG guided RFTC is considered first line treatment, LITT is another option that has been used successfully with similar epilepsy outcomes as resective surgery. 80,81 Laser interstitial thermal therapy has also been used successfully to perform disconnective epilepsy surgeries including corpus callosotomies (►Fig. 5) and hemispherotomies.…”

“…Although, sEEG guided RFTC is considered first line treatment, LITT is another option that has been used successfully with similar epilepsy outcomes as resective surgery. 80 81…”

An Introduction to Minimally Invasive Pediatric Epilepsy Surgery

“…The low morbidi-ty of LITT also allows us to target lesions that would previously be considered "inoperable," such as the hypothalamic hamartoma 6 or subependymal periventricular nodular heterotopia. 7 This older, traditional mindset totally excluded the intractable patient with multifocal epilepsy with multiple seizure types, except for a corpus callosotomy. However, it is now well recognized that some children have more than one apparent seizure focus, yet they can still be candidates for surgery and have an excellent outcome.…”

“…The low morbidity of LITT also allows us to target lesions that would previously be considered “inoperable,” such as the hypothalamic hamartoma 6 or subependymal periventricular nodular heterotopia. 7…”

Letter: The American Society for Stereotactic and Functional Neurosurgery Position Statement on Laser Interstitial Thermal Therapy for the Treatment of Drug-Resistant Epilepsy

“…6 In a pediatric case series of epilepsy related to periventricular nodular heterotopia, all patients experienced a decrease in seizure frequency, with complications including quadrantopia, hemianopia, and delayed intraparenchymal hemorrhage resulting in hemiparesis. 7 For corpus callosotomy using MRgLITT for treatment of pediatric DRE, 71% of patients had resolution of drop attacks on long-term follow-up with no persistent functional deficits. 8 Further investigation is required to establish factors associated with increased reoperation rate, increased seizure frequency post-treatment, and postoperative neurological deficits in MRgLITT.…”