Introduction: Craniotomy for resections of epileptogenic FCD lesions is effective. We report our early surgical experience employing minimally invasive laser ablation to treat pediatric patients harboring small epileptogenic cortical dyplasias.
Methods: From 5/29/13 through 3/6/14 we performed 38 pediatric epilepsy surgical procedures (excluding VNS) at our children’s hospital. Seven patients underwent laser ablation of their epileptogenic focal cortical dysplasia. Application energy was delivered with a stereotactic-directed 980 nanometer wavelength saline-cooled diode laser monitored with proton resonance frequency shift-base MR temperature (multislice) imaging.
Results: Seven patients ranging in age from 9 to 19 years (average 11 years) underwent laser ablation after their epilepsy evaluation confirmed focal onset seizures associated with a structural cortical abnormality believed to represent cortical dysplasia. Five patients remained seizure free after one surgery (average followup 4 months). Two patients required repeat ablation: one remains seizure-free following the second ablation; the other has experienced >90% seizure reduction and will undergo a third ablation due to the size of the epileptogenic lesion. All patients developed acute ablation edema that resolved within weeks. All patients received a course of steroids pre- and post ablation. Most hospital stays were shorter than 3 days. Longer hospitalizations were required by 2 patients: one, whose lesion lay within the medial motor strip, received prolonged rehab to address her resolving lower extremity monoparesis, becoming ambulatory once again; the other patient required inpatient recovery in the wake of uncontrolled, multiple seizures prompting the second ablation As of 25 March 2014, follow-ups for these patients range from 1 to 10 months (average 4 months).
Conclusions: Although followup for this small series of patients is short, laser ablation of epileptogenic focal cortical dysplasias may be promising for the control of focal onset epilepsy in children. Six of 7 patients in this series remain seizure-free. It remains to be demonstrated whether or not relief will prove durable.
Patient Care: Decrease operative morbidity; shorten hospital stay; allow less disruptive access to epileptogenic FCD foci located in insular or medial hemispheric regions, for example.
Learning Objectives: Participants will become aware of a promising non-invasive option for treating smaller areas of epileptogenic cortical dysplasia in pediatric patients.