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

被引:14
作者
Hect, Jasmine L. [1 ]
Alattar, Ali A. [1 ]
Harford, Emily E. [1 ]
Reecher, Hope [1 ]
Fernandes, David T. [1 ]
Esplin, Nathan [2 ]
McDowell, Michael [1 ]
Abel, Taylor J. [1 ,3 ,4 ]
机构
[1] Univ Pittsburgh, Dept Neurosurg, Med Ctr, Pittsburgh, PA 15260 USA
[2] Allegheny Hlth Network, Dept Neurosurg, Pittsburgh, PA USA
[3] Univ Pittsburgh, Swanson Sch Engn, Dept Bioengn, Pittsburgh, PA 15260 USA
[4] UPMC Presbyterian, Dept Neurol Surg, Suite B-400,200 Lothrop St, Pittsburgh, PA 15213 USA
基金
美国国家卫生研究院;
关键词
Laser interstitial thermal therapy; LITT; Epilepsy; TEMPORAL-LOBE EPILEPSY; CORPUS CALLOSOTOMY; ABLATION; AMYGDALOHIPPOCAMPOTOMY; SURGERY; OUTCOMES;
D O I
10.1007/s00381-022-05491-x
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
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.
引用
收藏
页码:961 / 970
页数:10
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