Single and staged laser interstitial thermal therapy ablation for cortical tubers causing refractory epilepsy in pediatric patients

Tovar-Spinoza, Zulma; Ziechmann, Robert; Zyck, Stephanie

doi:10.3171/2018.6.focus18228

Cited by 36 publications

(29 citation statements)

References 41 publications

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“…These procedures have included dentatolysis, fornicotomy, thalamotomy, hypothalamotomy, amygdalotomy and many others [136][137][138]. Today, stereotactic ablative techniques are used for limited conditions: arteriovenous and cavernous malformations, HHs, mesial temporal lobe sclerosis and, to a lesser extent, complex and deep focal cortical dysplasias, nodular periventricular heterotopias, tuberous sclerosis [139] and subependymal giant cell astrocytomas [140]. Favorable reports exist also for stereoelectroencephalography-guided surgery of neocortical nonlesional epilepsy [10].…”

Section: Drug-resistant Epilepsymentioning

confidence: 99%

Ablative brain surgery: an overview

Franzini

Moosa

Servello

et al. 2019

International Journal of Hyperthermia

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Background: Ablative therapies have been used for the treatment of neurological disorders for many years. They have been used both for creating therapeutic lesions within dysfunctional brain circuits and to destroy intracranial tumors and space-occupying masses. Despite the introduction of new effective drugs and neuromodulative techniques, which became more popular and subsequently caused brain ablation techniques to fall out favor, recent technological advances have led to the resurgence of lesioning with an improved safety profile. Currently, the four main ablative techniques that are used for ablative brain surgery are radiofrequency thermoablation, stereotactic radiosurgery, laser interstitial thermal therapy and magnetic resonance-guided focused ultrasound thermal ablation. Object: To review the physical principles underlying brain ablative therapies and to describe their use for neurological disorders. Methods: The literature regarding the neurosurgical applications of brain ablative therapies has been reviewed. Results: Ablative treatments have been used for several neurological disorders, including movement disorders, psychiatric disorders, chronic pain, drug-resistant epilepsy and brain tumors. Conclusions: There are several ongoing efforts to use novel ablative therapies directed towards the brain. The recent development of techniques that allow for precise targeting, accurate delivery of thermal doses and real-time visualization of induced tissue damage during the procedure have resulted in novel techniques for cerebral ablation such as magnetic resonance-guided focused ultrasound or laser interstitial thermal therapy. However, older techniques such as radiofrequency thermal ablation or stereotactic radiosurgery still have a pivotal role in the management of a variety of neurological disorders.

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Section: Drug-resistant Epilepsymentioning

confidence: 99%

Ablative brain surgery: an overview

Franzini

Moosa

Servello

et al. 2019

International Journal of Hyperthermia

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“…This feature makes LITT an attractive option for treating a variety of small focal lesions that cause epilepsy, such as focal cortical dysplasia (FCD), tuberous sclerosis complex, and periventricular tumors such as subependymal giant cell astrocytoma (SEGA). 6,16,17,41,62 The hypothalamic hamartoma (HH) is one such stereotypical deep-seated epileptogenic lesion. Given the deepseated location and the morbidity of an open procedure, some institutions have begun using LITT as first-line therapy for HH.…”

Section: Litt For Lesionsmentioning

confidence: 99%

Recent advances in the neurosurgical treatment of pediatric epilepsy

Roland¹,

Smyth²

2019

Journal of Neurosurgery: Pediatrics

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The field of epilepsy surgery has seen tremendous growth in recent years. Innovative new devices have driven much of this growth, but some has been driven by revisions of existing products. Devices have also helped to rejuvenate existing procedures, as in the case of robotic assistance for electrode placement for stereo-electroencephalography, and these devices have brought significant attention along with their introduction. Other devices, such as responsive neurostimulators or laser interstitial thermal therapy systems, have introduced novel treatment modalities and broadened the surgical indications. Collectively, these advances are rapidly changing much of the landscape in the world of pediatric neurosurgery for medically refractory epilepsy. The foundations for indications for neurosurgical intervention are well supported in strong research data, which has also been expanded in recent years. In this article, the authors review advances in the neurosurgical treatment of pediatric epilepsy, beginning with trials that have repeatedly demonstrated the value of neurosurgical procedures for medically refractory epilepsy and following with several recent advances that are largely focused on less-invasive intervention.

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“…The best evidence supporting the efficacy of LITT to treat patients with epilepsy with curative intent comes from the ablation of structurally well‐defined targets, including hypothalamic hamartoma and mesial temporal sclerosis 19‐21 . As experience increases, LITT is also being used to treat a growing list of epileptogenic substrates, including focal cortical dysplasia (FCD), cavernous malformation, and lesions in challenging anatomic locations such as the insula and functionally eloquent cortex 22‐24 . This increasing list of pathologies treated with LITT contrasts with the fact that there is no class I evidence comparing the efficacy and complication rates of LITT with those of standard surgical treatment.…”

Section: Introductionmentioning

confidence: 99%

“…These advantages have led to the proliferation of LITT to treat a broad range of epileptic conditions, many of which have yet to generate sufficient evidence to determine efficacy. This includes hemispheric disconnections such as corpus callosotomy using multiple lasers, 36 lesional and nonlesional focal epilepsy in deep and functionally eloquent anatomic locations such as the insula, 37 and focal and multifocal epilepsy in patients with cavernous malformation 38 or tuberous sclerosis complex 24 …”

Section: Introductionmentioning

confidence: 99%

How technology is driving the landscape of epilepsy surgery

et al. 2020

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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. K E Y W O R D Sepilepsy surgery, high-intensity focused ultrasound, intraoperative MRI, laser ablation, neuromodulation, robots 842 |

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Single and staged laser interstitial thermal therapy ablation for cortical tubers causing refractory epilepsy in pediatric patients

Cited by 36 publications

References 41 publications

Ablative brain surgery: an overview

Ablative brain surgery: an overview

Recent advances in the neurosurgical treatment of pediatric epilepsy

How technology is driving the landscape of epilepsy surgery

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