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  • Early Outcomes of Stereoelectroencephalography followed by MR-guided Laser Interstitial Thermal Therapy: A Paradigm for Minimally Invasive Epilepsy Surgery

    Final Number:

    Islam Fayed MD MS; Kelsey Diva Cobourn BS; Robert F. Keating MD; Chima Oluigbo MD

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2018 Annual Meeting

    Introduction: Stereotactic electroencephalography (sEEG) and magnetic resonance guided laser interstitial thermal therapy (MRgLITT) have both emerged as minimally invasive alternatives to open surgery for the localization and treatment of medically refractory lesional epilepsy. Data remains limited on the use of these procedures individually and is almost non-existent on their use in conjunction. Our aim is to report early outcomes regarding efficacy and safety of sEEG followed by MRgLITT for localization and ablation of seizure foci in the pediatric population of medically refractory lesional epilepsy.

    Methods: A single-center retrospective review of pediatric patients who underwent sEEG followed by MRgLITT procedures was performed. Demographic, intraoperative, and outcome data were compiled and analyzed.

    Results: Four pediatric patients with nine total lesions underwent sEEG followed by MRgLITT procedures between January and September 2017. Mean age at surgery was 10.75 (2-21) years. Surgical substrates included two patients with tuberous sclerosis and two patients with focal cortical dysplasia. Methods of stereotaxis consisted of BrainLab Varioguide and ROSA robotic guidance, with successful localization of seizure foci in all cases. sEEG procedure length averaged 153 (67-235) minutes, with a mean of 6 (4-8) electrodes and 56 (18-84) contacts per patient. MRgLITT procedure length averaged 223 (179-252) minutes. Mean duration of monitoring was 5.75 (4-8) days, and mean total hospital stay was 8 (5-11) days. Over a mean follow-up duration of 5.75 (3-10) months, three patients were seizure free (Engel I, 75%), while one patient saw significant improvement in seizure frequency (Engel II, 25%). There were no complications.

    Conclusions: This early data demonstrates that sEEG followed by MRgLITT can safely and effectively localize and ablate epileptogenic foci in a minimally invasive paradigm for treatment of medically refractory lesional epilepsy in pediatric populations. Continued collection of data with extended follow-up is needed.

    Patient Care: This study presents early outcome data demonstrating the safety and efficacy of stereoelectroencephalography followed by MR-guided laser interstitial thermal therapy. As more data is collected, these techniques will help shape a paradigm for minimally invasive epilepsy surgery by both improving outcomes and decreasing morbidity associated with such procedures.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Understand the incidence of and treatment options for pediatric refractory lesional epilepsy 2) Describe the operative techniques for stereoelectroencephalography and MR-guided laser interstitial thermal therapy 3) Discuss the advantages of minimally invasive epilepsy surgery 4) Identify patients who would benefit from minimally invasive epilepsy surgery

    References: 1. Kwan P, Schachter SC, Brodie MJ. Drug-resistant epilepsy. N Engl J Med. 2011;365(10):919–926. 2. Russ SA, Larson K, Halfon N. A national profile of childhood epilepsy and seizure disorder. Pediatrics. 2012;129(2):256-264. doi:10.1542/peds.2010-1371 3. Freitag H, Tuxhorn I. Cognitive function in preschool children after epilepsy surgery: rationale for early intervention. Epilepsia. 2005;46(4):561–567. 4. Naegele J. Epilepsy and the Plastic Mind. Epilepsy Curr. 2009;9(6):166-169. doi:10.1111/j.1535-7511.2009.01331.x 5. Buckley R, Estronza-Ojeda S, Ojemann JG. Laser Ablation in Pediatric Epilepsy. Neurosurg Clin N Am. 2016;27(1):69–78. 6. Cossu M, Cardinale F, Colombo N, et al. Stereoelectroencephalography in the presurgical evaluation of children with drug-resistant focal epilepsy. J Neurosurg Pediatr. 2005;103(4):333–343. 7. Cossu M, Schiariti M, Francione S, et al. Stereoelectroencephalography in the presurgical evaluation of focal epilepsy in infancy and early childhood. J Neurosurg Pediatr. 2012;9(3):290–300. 8. Diaz R, Ivan ME, Hanft S, et al. Laser interstitial thermal therapy: lighting the way to a new treatment option in neurosurgery. Neurosurgery. 2016;79(suppl_1):S3–S7. 9. Gonzalez-Martinez J, Mullin J, Vadera S, et al. Stereotactic placement of depth electrodes in medically intractable epilepsy. J Neurosurg. 2014;120(3):639–644. 10. Hoppe C, Witt J-A, Helmstaedter C, Gasser T, Vatter H, Elger CE. Laser interstitial thermotherapy (LiTT) in epilepsy surgery. Seizure-Eur J Epilepsy. 2017;48:45–52. 11. Patel P, Patel NV, Danish SF. Intracranial MR-guided laser-induced thermal therapy: single-center experience with the Visualase thermal therapy system. J Neurosurg. 2016;125(4):853–860. 12. Ravindra VM, Sweney MT, Bollo RJ. Recent developments in the surgical management of paediatric epilepsy. Arch Dis Child. 2017:archdischild–2016. 13. Engel J. Why is there still doubt to cut it out? Epilepsy Curr. 2013;13(5):198-204. doi:10.5698/1535-7597-13.5.198 14. Karsy M, Guan J, Ducis K, Bollo RJ. Emerging surgical therapies in the treatment of pediatric epilepsy. Transl Pediatr. 2016;5(2):67-78. doi:10.21037/tp.2016.04.01 15. Reisch R, Stadie A, Kockro RA, Hopf N. The Keyhole Concept in Neurosurgery. World Neurosurg. 2013;79(2):S17.e9-S17.e13. doi:10.1016/j.wneu.2012.02.024 16. Willie JT, Laxpati NG, Drane DL, et al. Real-time magnetic resonance-guided stereotactic laser amygdalohippocampotomy for mesial temporal lobe epilepsy. Neurosurgery. 2014;74(6):569-584; discussion 584-585. doi:10.1227/NEU.0000000000000343 17. Bancaud J. Techniques et méthodes de l’exploration fonctionnelle stéréotaxique des structures encéphaliques chez l’homme (cortex, sous-cortex, noyaux gris centraux). Rev Neurol. 1959. 18. Cardinale F, Cossu M, Castana L, et al. Stereoelectroencephalography: surgical methodology, safety, and stereotactic application accuracy in 500 procedures. Neurosurgery. 2012;72(3):353–366. 19. González-Martínez J, Bulacio J, Thompson S, et al. Technique, results, and complications related to robot-assisted stereoelectroencephalography. Neurosurgery. 2015;78(2):169–180. 20. Cossu M, Cardinale F, Castana L, et al. Stereoelectroencephalography in the presurgical evaluation of focal epilepsy: a retrospective analysis of 215 procedures. Neurosurgery. 2005;57(4):706–718. 21. Gonzalez-Martinez J, Vadera S, Mullin J, et al. Robot-assisted stereotactic laser ablation in medically intractable epilepsy: operative technique. Oper Neurosurg. 2014;10(2):167–173. 22. Serletis D, Bulacio J, Bingaman W, Najm I, González-Martínez J. The stereotactic approach for mapping epileptic networks: a prospective study of 200 patients. J Neurosurg. 2014;121(5):1239–1246. 23. Esquenazi Y, Kalamangalam GP, Slater JD, et al. Stereotactic laser ablation of epileptogenic periventricular nodular heterotopia. Epilepsy Res. 2014;108(3):547-554. doi:10.1016/j.eplepsyres.2014.01.009 24. Cardinale F, Casaceli G, Raneri F, Miller J, Russo GL. Implantation of stereoelectroencephalography electrodes: a systematic review. J Clin Neurophysiol. 2016;33(6):490–502.

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