Dataset Information

Magnetic resonance imaging-guided stereotactic laser ablation therapy for the treatment of pediatric epilepsy: a retrospective multiinstitutional study.

ABSTRACT:

Objective

The authors of this study evaluated the safety and efficacy of stereotactic laser ablation (SLA) for the treatment of drug-resistant epilepsy (DRE) in children.

Methods

Seventeen North American centers were enrolled in the study. Data for pediatric patients with DRE who had been treated with SLA between 2008 and 2018 were retrospectively reviewed.

Results

A total of 225 patients, mean age 12.8 ± 5.8 years, were identified. Target-of-interest (TOI) locations included extratemporal (44.4%), temporal neocortical (8.4%), mesiotemporal (23.1%), hypothalamic (14.2%), and callosal (9.8%). Visualase and NeuroBlate SLA systems were used in 199 and 26 cases, respectively. Procedure goals included ablation (149 cases), disconnection (63), or both (13). The mean follow-up was 27 ± 20.4 months. Improvement in targeted seizure type (TST) was seen in 179 (84.0%) patients. Engel classification was reported for 167 (74.2%) patients; excluding the palliative cases, 74 (49.7%), 35 (23.5%), 10 (6.7%), and 30 (20.1%) patients had Engel class I, II, III, and IV outcomes, respectively. For patients with a follow-up ≥ 12 months, 25 (51.0%), 18 (36.7%), 3 (6.1%), and 3 (6.1%) had Engel class I, II, III, and IV outcomes, respectively. Patients with a history of pre-SLA surgery related to the TOI, a pathology of malformation of cortical development, and 2+ trajectories per TOI were more likely to experience no improvement in seizure frequency and/or to have an unfavorable outcome. A greater number of smaller thermal lesions was associated with greater improvement in TST. Thirty (13.3%) patients experienced 51 short-term complications including malpositioned catheter (3 cases), intracranial hemorrhage (2), transient neurological deficit (19), permanent neurological deficit (3), symptomatic perilesional edema (6), hydrocephalus (1), CSF leakage (1), wound infection (2), unplanned ICU stay (5), and unplanned 30-day readmission (9). The relative incidence of complications was higher in the hypothalamic target location. Target volume, number of laser trajectories, number or size of thermal lesions, or use of perioperative steroids did not have a significant effect on short-term complications.

Conclusions

SLA appears to be an effective and well-tolerated treatment option for children with DRE. Large-volume prospective studies are needed to better understand the indications for treatment and demonstrate the long-term efficacy of SLA in this population.

SUBMITTER: Arocho-Quinones EV

PROVIDER: S-EPMC10193482 | biostudies-literature | 2023 Mar

REPOSITORIES: biostudies-literature

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Magnetic resonance imaging-guided stereotactic laser ablation therapy for the treatment of pediatric epilepsy: a retrospective multiinstitutional study.

Arocho-Quinones Elsa V EV Lew Sean M SM Handler Michael H MH Tovar-Spinoza Zulma Z Smyth Matthew D MD Bollo Robert J RJ Donahue David D Perry M Scott MS Levy Michael M Gonda David D Mangano Francesco T FT Kennedy Benjamin C BC Storm Phillip B PB Price Angela V AV Couture Daniel E DE Oluigbo Chima C Duhaime Ann-Christine AC Barnett Gene H GH Muh Carrie R CR Sather Michael D MD Fallah Aria A Wang Anthony C AC Bhatia Sanjiv S Eastwood Daniel D Tarima Sergey S Graber Sarah S Huckins Sean S Hafez Daniel D Rumalla Kavelin K Bailey Laurie L Shandley Sabrina S Roach Ashton A Alexander Erin E Jenkins Wendy W Tsering Deki D Price George G Meola Antonio A Evanoff Wendi W Thompson Eric M EM Brandmeir Nicholas N

Journal of neurosurgery. Pediatrics 20230303

<h4>Objective</h4>The authors of this study evaluated the safety and efficacy of stereotactic laser ablation (SLA) for the treatment of drug-resistant epilepsy (DRE) in children.<h4>Methods</h4>Seventeen North American centers were enrolled in the study. Data for pediatric patients with DRE who had been treated with SLA between 2008 and 2018 were retrospectively reviewed.<h4>Results</h4>A total of 225 patients, mean age 12.8 ± 5.8 years, were identified. Target-of-interest (TOI) locations includ ...[more]

PMID: 36883640

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Project description:ObjectiveCorpus callosotomy (CC) is an important treatment for atonic seizures in patients with generalized or multifocal drug-resistant epilepsy (DRE). Traditionally, CC is performed via an open microsurgical approach, but more recently, MR-guided stereotactic laser interstitial thermal therapy (LITT) corpus callosum ablation (CCA) has been developed to leverage the safety and minimally invasive nature of LITT. Given the recent adoption of CCA at select centers, how CCA compares to CC is unknown. We aim to compare the clinical seizure outcomes of CCA and CC after extended follow-up.MethodsWe performed a retrospective cohort study to compare the effectiveness and safety of CC to CCA from 1994 to 2022. The primary outcome was a 50% reduction in target seizure. Secondary outcome measures were postoperative length of stay, adverse events, and other effectiveness metrics. Comparative statistics were executed using Stata. Normality for continuous variables was assessed, and parametric statistics were utilized as needed. Frequency was compared with chi-squared or Fischer's exact tests, when applicable.ResultsData from 47 operations performed on 36 patients were included in this study, of which 13 (36%) patients underwent 17 CCA. Patients who received CCA had similar rates of meaningful reduction (>50%) of atonic seizures as their CC counterparts (55% vs 70% P = 0.15). Patients undergoing CCA had significantly shorter hospitalizations than those receiving CC (2.5 vs 6.0 days P < 0.001). There was no significant difference in rates of postoperative complications between the groups, although the magnitude of the complication rates was lower in the CCA cohort (12% vs 28%).SignificanceThis early experience suggests CCA has similar outcomes to traditional CC, albeit with a shorter hospital stay. However, future studies are necessary to investigate the noninferiority between these two approaches. Large multicenter studies are necessary to investigate differences in adverse events and whether these findings generalize across other centers.

Project description:BackgroundMagnetic resonance-guided laser interstitial thermal therapy (MRgLITT) and traditional open surgery (OS) are effective and safe options for patients with drug-resistant mesial temporal lobe epilepsy (DR-mTLE). However, their superiority in seizure control and preservation of functional abilities remains unclear. This study aimed to compare the surgical outcomes of MRgLITT and OS.Materials and methodsThis multicenter retrospective cohort study included patients with DR-mTLE who underwent MRgLITT or OS at three centers between 2015 and 2023. The data on patient demographics, presurgical non-invasive evaluation, stereoelectroencephalography (SEEG) implantation, memory alteration, and seizure outcomes were collected. A propensity score matching (PSM) analysis was conducted to minimize selection bias, facilitating a comparison of seizure control and functional preservation between two surgical approaches.ResultsOf the 244 individuals who met the study criteria, 33 underwent MRgLITT and 211 OS. The median (IQR) age at seizure onset was 22.0 (13.0) and 12.3 (10.0) years in the MRgLITT and OS groups, respectively. The first PSM, based on demographic and non-invasive information, resulted in 26 matched pairs for the primary analysis. There were no significant differences in memory preservation (P = .95) or surgical outcomes (P = .96) between the groups. The second PSM, based on demographics and SEEG implantation, yielded 32 matched pairs for the sensitivity analysis, showing similar results. Subset analysis of early and late MRgLITT cases revealed no statistically significant differences in the proportion of patients with memory decline (P = .42) or seizure control (P = 1.00). Patients who underwent SEEG implantation were 96% less likely to achieve seizure freedom after MRgLITT (P = .02).ConclusionMinimally invasive MRgLITT is associated with memory preservation and seizure control, similar to traditional OS. MRgLITT is effective and safe for DR-mTLE and is relevant for future prospective randomized trials on dominant-side mTLE, providing practical implications for guiding neurosurgeons in the selection of surgical approaches.

Dataset Information

Magnetic resonance imaging-guided stereotactic laser ablation therapy for the treatment of pediatric epilepsy: a retrospective multiinstitutional study.

Objective

Methods

Results

Conclusions

Publications

Magnetic resonance imaging-guided stereotactic laser ablation therapy for the treatment of pediatric epilepsy: a retrospective multiinstitutional study.

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