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Stereotactic laser interstitial thermal therapy for the treatment of pediatric drug-resistant epilepsy: indications, techniques, and safety

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Abstract

Background

MRI-guided laser interstitial thermal therapy (MRgLITT) is a promising alternative to open surgery for treatment of drug-resistant epilepsy, offering significant advantages over traditional approaches for candidate patients, including minimally invasive approach, shorter hospitalization, and decreased patient post-operative discomfort. LITT uses a stereotactically placed fiber optic laser probe to ablate tissue under real-time MR thermometry.

Methods

Retrospective chart review of intraoperative and perioperative characteristics was performed for 28 cases of MRgLITT in 25 pediatric patients, ages 4–21 years old, at our institution between 2019 and 2021. MRgLITT ablation of the mesial temporal lobe was performed in 8 cases, extratemporal epileptogenic foci in 9 cases, and for corpus callosotomy in 11 cases.

Results

At 1 year of follow-up, 53% of all patients experienced improvement in seizure frequency (Engel I or II) (class I: 38%, class II: 15%, class III: 17%, class IV: 31%), including 37% of MTL ablations and 80% extratemporal SOZ ablations. After MRgLITT corpus callosotomy, 71% of patients were free from atonic seizures at most recent follow-up. Median length of hospitalization was 2 days (1–3), including a median ICU stay of 1 day (1–2).

Conclusion

This series demonstrates the safety of MRgLITT as an approach for seizure control in drug-resistant epilepsy. We provide additional evidence that MRgLITT is an effective procedure that is well-tolerated by pediatric patients and is accompanied by an acceptable rate of complications and relatively short hospital stay.

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Acknowledgements

The authors acknowledge the patient and their family.

Funding

Research reported in this publication was supported by the National Institute of General Medical Sciences of the National Institutes of Health under Award Number T32GM008208. Dr. Abel reports funding from awards R21 DC019217-01A1 and R01 DC013315-07. Jasmine L. Hect reports funding from T32GM008208. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Author notes

  1. Jasmine L. Hect and Ali A. Alattar contributed equally.

Authors and Affiliations

  1. Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, USA

    Jasmine L. Hect, Ali A. Alattar, Emily E. Harford, Hope Reecher, David T. Fernandes, Michael McDowell & Taylor J. Abel

  2. Department of Neurosurgery, Allegheny Health Network, Pittsburgh, USA

    Nathan Esplin

  3. Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, USA

    Taylor J. Abel

  4. Department of Neurological Surgery, UPMC Presbyterian, Suite B-400, 200 Lothrop Street, Pittsburgh, PA, 15213, USA

    Taylor J. Abel

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  1. Jasmine L. Hect
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Correspondence to Taylor J. Abel.

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Conflict of interest

Dr. Abel is a consultant for Monteris Medical and receives research funding through Monteris Medical for the LAANTERN Trial.

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Hect, J.L., Alattar, A.A., Harford, E.E. et al. Stereotactic laser interstitial thermal therapy for the treatment of pediatric drug-resistant epilepsy: indications, techniques, and safety. Childs Nerv Syst 38, 961–970 (2022). https://doi.org/10.1007/s00381-022-05491-x

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