Introduction: MR-guided Laser Interstitial Thermal Therapy (MRgLITT) has emerged as a safe and effective treatment option for the ablation of epileptic foci, namely hypothalamic hamartomas, periventricular heterotopias, tuberous sclerosis, and deep cortical dysplasias. The minimally invasive nature of this procedure makes it attractive to both neurosurgeons and their patients due to decreased morbidity and hospital stay, particularly in pediatric populations. The objective of this study is to report the efficacy and safety of MRgLITT as a minimally invasive procedure for the ablation of epileptic foci in the pediatric population of medically refractory lesional epilepsy.
Methods: A retrospective review of patients who underwent MRgLITT via Visualase laser ablation by the senior author at a single pediatric center was performed. Demographic and outcomes data were compiled and analyzed.
Results: Thirteen pediatric patients with 20 total lesions underwent MRgLITT procedures between December 2013 and January 2018. Mean age at surgery was 11.6 years (2-22 years). Surgical substrates included four hypothalamic hamartomas, three periventricular heterotopias, three deep focal cortical dysplasias, two tuberous sclerosis, and one mesiotemporal sclerosis. Methods of stereotaxis included Leksell frame, BrainLab Varioguide, ROSA robot guidance, and ClearPoint navigation. Mean procedure length was 236.1 minutes, and mean length of stay was 1.27 days. After treatment, nine patients were seizure free (Engel I, 69.2%), two patients demonstrated significant improvement (Engel II, 15.4%), and two patients showed worthwhile improvement (Engel II, 15.4%). One patient developed a left superior quadrantanopsia. Outcomes were documented over a mean follow-up duration of 10 months.
Conclusions: This study demonstrates the high efficacy and low morbidity of MRgLITT as a minimally invasive method of ablation of epileptic foci in the pediatric population of medically refractory lesional epilepsy. More data may be collected in the coming years as this type of procedure gains favor among epilepsy surgeons.
Patient Care: This study presents data demonstrating the safety and efficacy of MR-guided laser interstitial thermal therapy for pediatric patients with refractory lesional epilepsy with the goal of improving outcomes and decreasing morbidity associated with epilepsy surgery.
Learning Objectives: 1) Understand the incidence of and treatment options for pediatric refractory lesional epilepsy
2) Describe the operative techniques for MR-guided laser interstitial thermal therapy
3) Discuss the advantages of minimally invasive epilepsy surgery
4) Identify patients who would benefit from MR-guided laser interstitial thermal therapy