Stereotactic laser anterior corpus callosotomy for Lennox‐Gastaut syndrome

Abstract

Objective: Corpus callosotomy is an effective palliative treatment for drug-resistant Lennox-Gastaut syndrome (LGS). Laser interstitial thermal therapy has been increasingly used in the treatment of epilepsy. Here, we assess the safety and effectiveness of minimally invasive stereotactic laser anterior corpus callosotomy (SLACC) for drop attacks in LGS. Methods: We reviewed sequential cases of patients with medically intractable LGS who underwent SLACC using a two-cannula technique between November 2014 and July 2019. Pre-and postoperative magnetic resonance imaging was used to measure the anteroposterior length of callosal ablation (contrast-enhancing lesion) and estimated disconnection (gap in tract projections on diffusion tensor imaging). Patients were followed longitudinally to assess clinical outcomes. Results: Ten patients were included in this study. The median age was 33 (range = 11-52) years, median duration of epilepsy was 26 (range = 10-49) years, and median duration of postoperative follow-up was 19 (range = 6-40) months. In the anteroposterior direction, 53 ± 7% (mean ± SD) of the corpus callosum was ablated and 62 ± 19% of the corpus callosum was estimated to be disconnected. Six (60%) of 10 patients achieved >80% seizure reduction, two (20%) of whom became seizure-free. Eight (80%) patients had >80% reduction in drop attacks, five (50%) of whom became free of drop attacks. Three patients subsequently underwent laser posterior callosotomy with further improvement in drop attacks and/or overall seizure frequency.One patient had an asymptomatic intracerebral hemorrhage along the cannula tract.One patient developed significant aggression after becoming seizure-free. Significance: Seizure outcomes following SLACC were comparable to previously reported outcomes of open callosotomy, with reasonable safety profile. SLACC appears to be an effective alternative to open anterior corpus callosotomy with minimal postoperative discomfort and a short recovery period.

Stereotactic laser interstitial thermal therapy corpus callosotomy for the treatment of pediatric drug‐resistant epilepsy

“…10,11 MRgLITT offers significant advantages to open callosotomy, including its minimally invasive nature, shorter hospitalization and operative time, decreased total blood loss, and comparable seizure control rates. [11][12][13] Various studies have demonstrated LITT callosotomy as an effective therapy for reducing seizure rates in adult 12,[14][15][16][17][18][19][20][21][22] and pediatric 11,16,23,24 patients with drug-resistant epilepsy, with comparable effectiveness to open callosotomy. 11 This study presents experience performing MRgLITT callosotomy for the treatment of drug-resistant epilepsy characterized by drop attacks in pediatric patients at a tertiary academic center.…”

Expanding the Treatment Landscape for Lennox-Gastaut Syndrome: Current and Future Strategies

“…Corpus callosotomy is performed either as an anterior two-thirds disconnection of corpus callosum or as a complete disconnection [158], generally performed either through an open approach via a standard craniotomy with the aid of an operating microscope, or alternatively via a mini-craniotomy with endoscope assistance, with the latter having the benefit of a smaller incision, minimised brain retraction, and lower postoperative pain [158]. More recently, a minimally invasive method-magnetic resonance imaging (MRI)-guided stereotactic laser interstitial thermal therapy (LITT)-has shown promising results in case reports [159][160][161][162][163][164][165][166][167]. In the largest study to date, investigating MRI-guided stereotactic laser anterior corpus callosotomy (SLACC) in 10 patients with LGS (median age 33 years, range 11-52 years), eight (80%) patients had > 80% reduction in drop attacks, of whom five (50%) became free of drop attacks, and six (60%) achieved > 80% seizure reduction, with two (20%) becoming seizure free [167].…”

“…More recently, a minimally invasive method-magnetic resonance imaging (MRI)-guided stereotactic laser interstitial thermal therapy (LITT)-has shown promising results in case reports [159][160][161][162][163][164][165][166][167]. In the largest study to date, investigating MRI-guided stereotactic laser anterior corpus callosotomy (SLACC) in 10 patients with LGS (median age 33 years, range 11-52 years), eight (80%) patients had > 80% reduction in drop attacks, of whom five (50%) became free of drop attacks, and six (60%) achieved > 80% seizure reduction, with two (20%) becoming seizure free [167]. In addition, the complications of SLACC were minimal (one asymptomatic tract haemorrhage and no cases of disconnection syndrome), and patients had short hospital stays and minimal postoperative discomfort.…”

Surgical Aspects of Corpus Callosotomy

“…To reduce the invasiveness with craniotomy, stereotactic laser CC [ 15 , 16 ] and radiosurgical CC [ 17 ] have recently been developed. These techniques reportedly provide favorable seizure outcomes with low complication rates, comparable to the above-mentioned conventional CC with craniotomy.…”