MR-guided stereotactic laser ablation of epileptogenic foci in children

Curry, Daniel J.; Gowda, Ashok; McNichols, Roger J.; Wilfong, Angus A.

doi:10.1016/j.yebeh.2012.04.135

Cited by 409 publications

(245 citation statements)

References 20 publications

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“…In 2012, Curry and his team at Texas Children's Hospital [12] first reported the feasibility and efficacy of MRI-guided LiTT in ablating epileptic lesions in 5 pediatric patients. Since then, laser has been used to ablate a variety of epileptogenic lesions, including periventricular nodular heterotopia [13], tuberous sclerosis [14], cortical dysplasia [12,14], insular encephalomalacia [15], hypothalamic hamartomas (HH), and MTLE [7,12,16,17]. Although the literature on outcomes is limited to a handful reports, MRguided LiTT is a promising treatment alternative to open resections in patients with MTLE and HH.…”

Section: Application and Efficacymentioning

confidence: 99%

Magnetic Resonance Imaging-Guided Laser Interstitial Thermal Therapy for Treatment of Drug-Resistant Epilepsy

Kang

Sperling

2017

Neurotherapeutics

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Surgery is the most effective treatment for drug-resistant epilepsy. Long-term studies demonstrate that about 60% to 80% of patients become seizure-free after anterior temporal lobectomy and a majority of patients (about 95%) report significant seizure reduction after surgery. In the last few years, there has been significant advances in minimally invasive surgical techniques to treat drug-resistant epilepsy. These minimally invasive procedures have significant advantages over open surgery in that they produce less immediate discomfort and disability, while allowing for greater preservation of functional tissue. Laser interstitial thermal therapy (LiTT) is an example of such a procedure. Recent advances in imaging, surgical navigation, and real-time thermal monitoring have made LiTT safer and easier to implement, offering an effective and powerful neurosurgical tool for drug-resistant epilepsy. This article will review the technical considerations, uses, and potential future directions for LiTT in drugresistant epilepsy.

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Section: Application and Efficacymentioning

confidence: 99%

Magnetic Resonance Imaging-Guided Laser Interstitial Thermal Therapy for Treatment of Drug-Resistant Epilepsy

Kang

Sperling

2017

Neurotherapeutics

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“…These may take the form of radiofrequency ablation or MR-guided laser-assisted ablation (Visualase, Inc.). 6,10,11,32 Moreover, stereotactic mapping of functional networks has now been rendered possible by using a combination of implanted SEEG electrodes and corticocortical evoked potentials elicited to identify white matter tracts, 7,16 thereby paving the way for ongoing anatomical and functional mapping of these pathways.…”

Section: Future Directions For Seegmentioning

confidence: 99%

The stereotactic approach for mapping epileptic networks: a prospective study of 200 patients

Serletis

Bulacio

Bingaman

et al. 2014

JNS

155

117

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Object Stereoelectroencephalography (SEEG) is a methodology that permits accurate 3D in vivo electroclinical recordings of epileptiform activity. Among other general indications for invasive intracranial electroencephalography (EEG) monitoring, its advantages include access to deep cortical structures, its ability to localize the epileptogenic zone when subdural grids have failed to do so, and its utility in the context of possible multifocal seizure onsets with the need for bihemispheric explorations. In this context, the authors present a brief historical overview of the technique and report on their experience with 2 SEEG techniques (conventional Leksell frame-based stereotaxy and frameless stereotaxy under robotic guidance) for the purpose of invasively monitoring difficult-to-localize refractory focal epilepsy. Methods Over a period of 4 years, the authors prospectively identified 200 patients with refractory epilepsy who collectively underwent 2663 tailored SEEG electrode implantations for invasive intracranial EEG monitoring and extraoperative mapping. The first 122 patients underwent conventional Leksell frame-based SEEG electrode placement; the remaining 78 patients underwent frameless stereotaxy under robotic guidance, following acquisition of a stereotactic ROSA robotic device at the authors' institution. Electrodes were placed according to a preimplantation hypothesis of the presumed epileptogenic zone, based on a standardized preoperative workup including video-EEG monitoring, MRI, PET, ictal SPECT, and neuropsychological assessment. Demographic features, seizure semiology, number and location of implanted SEEG electrodes, and location of the epileptogenic zone were recorded and analyzed for all patients. For patients undergoing subsequent craniotomy for resection, the type of resection and procedure-related complications were prospectively recorded. These results were analyzed and correlated with pathological diagnosis and postoperative seizure outcomes. Results The epileptogenic zone was confirmed by SEEG in 154 patients (77%), of which 134 (87%) underwent subsequent craniotomy for epileptogenic zone resection. Within this cohort, 90 patients had a minimum follow-up of at least 12 months; therein, 61 patients (67.8%) remained seizure free, with an average follow-up period of 2.4 years. The most common pathological diagnosis was focal cortical dysplasia Type I (55 patients, 61.1%). Per electrode, the surgical complications included wound infection (0.08%), hemorrhagic complications (0.08%), and a transient neurological deficit (0.04%) in a total of 5 patients (2.5%). One patient (0.5%) ultimately died due to intracerebral hematoma directly ensuing from SEEG electrode placement. Conclusions Based on these results, SEEG methodology is safe, reliable, and effective. It is associated with minimal morbidity and mortality, and serves as a practical, minimally invasive approach to extraoperative localization of the epileptogenic zone in patients with refractory epilepsy.

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“…Available minimally invasive treatment options such as SRS 64,65 and RF ablation 65 offer the potential benefit of decreasing iatrogenic complications, but the inability to monitor ablation in real-time diminishes their margin of safety. A pilot study by Curry et al 52 first demonstrated the feasibility of MRgLITT in the successful treatment of medically intractable epileptic foci. To date, studies report laser ablation of tuberous sclerosis, hypothalamic hamartoma, mesial temporal sclerosis, cortical dysplasia, and periventricular nodular hyperplasia with follow-up ranging from 2 to 13 months.…”

Section: Epilepsymentioning

confidence: 99%

Current Applications of MRI-Guided Laser Interstitial Thermal Therapy in the Treatment of Brain Neoplasms and Epilepsy: A Radiologic and Neurosurgical Overview

Medvid¹,

Ruiz²,

Komotar

et al. 2015

AJNR Am J Neuroradiol

179

125

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SUMMARY:Minimally invasive stereotactic tumor ablation is a viable option for the treatment of benign and malignant intracranial lesions. Although surgical excision constitutes first-line therapy for various brain pathologies, it can cause irreversible neurologic deficits. Additionally, many patients who may benefit from surgery do not qualify as surgical candidates due to multiple comorbidities. Recent advancements in laser interstitial thermal therapy, namely the ability to monitor ablation in real-time under MR imaging, have improved the safety and efficacy of the procedure. MRI-guided laser interstitial thermal therapy is currently used as a minimally invasive treatment for brain metastases, radiation necrosis, glioma, and epilepsy. This article will discuss the principles, suggested indications, complications, and imaging characteristics of MRI-guided laser interstitial thermal therapy as they pertain to the treatment of brain pathology. ABBREVIATIONS:GBM ϭ glioblastoma multiforme; LITT ϭ laser interstitial thermal therapy; MRgLITT ϭ MRI-guided laser interstitial thermal therapy; MRTI ϭ MRI thermal imaging; RN ϭ delayed radiation necrosis; SRS ϭ stereotactic radiosurgery

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MR-guided stereotactic laser ablation of epileptogenic foci in children

Cited by 409 publications

References 20 publications

Magnetic Resonance Imaging-Guided Laser Interstitial Thermal Therapy for Treatment of Drug-Resistant Epilepsy

Magnetic Resonance Imaging-Guided Laser Interstitial Thermal Therapy for Treatment of Drug-Resistant Epilepsy

The stereotactic approach for mapping epileptic networks: a prospective study of 200 patients

Current Applications of MRI-Guided Laser Interstitial Thermal Therapy in the Treatment of Brain Neoplasms and Epilepsy: A Radiologic and Neurosurgical Overview

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