Introduction: Stereotactic laser ablation (SLA) with real-time MR thermographic monitoring is a new technology that offers minimally invasive ablation of intracranial tissue with the potential for improved precision and control compared to other stereotactic ablation technologies. Few reports address the use of this technique for cortically-based epileptogenic lesions.
Methods: A single-center retrospective review was conducted of consecutive patients who underwent SLA for treatment of epilepsy caused by cortically-based lesions. All patients underwent the standard thorough epilepsy pre-surgical evaluation at a multi-disciplinary conference.
Results: Five patients with epilepsy have undergone SLA for cortical lesions, three with glio-neural tumors and 2 with focal cortical dysplasia. Age at treatment ranged from 10 to 14 years. Locations of lesions include basal temporal (2), medial occipital, frontal convexity, and lateral frontal (Broca). Lesion size ranged from 0.25 to 12.4 cm3 (mean 6.0). Three patients had two catheters placed while the remaining had a single catheter. Only two of the lesions were completely ablated as judged by the ablation zone visualized on gadolinium enhanced MRI at the end of the procedure.
All patients are seizure free. Follow-up ranges from 1 to 13 months (mean 6.7). No complications occurred. Length of stay was 1 or 2 nights for all patients.
Conclusions: SLA can be effective for the treatment of epilepsy caused by small, well-localized cortical lesions. Longer follow-up is needed to fully assess efficacy.
Patient Care: This work describes a less invasive, potentially less mobid option for treatment of cortically based seizure foci.
Learning Objectives: By the conclusion of this session, participants should be able to 1) recognize the difference between stereotactic laser ablation (SLA) and open resection of cortically based lesions, 2) understand the preliminary nature of this work given the short follow-up and small number of patients, 3) appreciate the potential patient benfits from SLA.