Anterior Corpus Callosotomy Using Laser Interstitial Thermal Therapy for Refractory Epilepsy

Ball, Tyler; Sharma, Mayur; White, Andrew C.

doi:10.1159/000495414

Cited by 34 publications

(20 citation statements)

References 20 publications

(25 reference statements)

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“…Ball et al reported using LITT for anterior corpus callosotomy in a 21-year-old male. 3 They also used a 2-laser fiber configuration with a posterior approach to the body of the CC. We found an anterior approach to the CC body to be more favorable than a posterior approach as described in the literature to date.…”

Section: Review Of the Literature To Datementioning

confidence: 99%

Corpus callosotomy performed with laser interstitial thermal therapy

Roland

Akbari

Salehi

et al. 2021

Journal of Neurosurgery

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OBJECTIVECorpus callosotomy is a palliative procedure that is effective at reducing seizure burden in patients with medically refractory epilepsy. The procedure is traditionally performed via open craniotomy with interhemispheric microdissection to divide the corpus callosum. Concerns for morbidity associated with craniotomy can be a deterrent to patients, families, and referring physicians for surgical treatment of epilepsy. Laser interstitial thermal therapy (LITT) is a less invasive procedure that has been widely adopted in neurosurgery for the treatment of tumors. In this study, the authors investigated LITT as a less invasive approach for corpus callosotomy.METHODSThe authors retrospectively reviewed all patients treated for medically refractory epilepsy by corpus callosotomy, either partial or completion, with LITT. Chart records were analyzed to summarize procedural metrics, length of stay, adverse events, seizure outcomes, and time to follow-up. In select cases, resting-state functional MRI was performed to qualitatively support effective functional disconnection of the cerebral hemispheres.RESULTSTen patients underwent 11 LITT procedures. Five patients received an anterior two-thirds LITT callosotomy as their first procedure. One patient returned after LITT partial callosotomy for completion of callosotomy by LITT. The median hospital stay was 2 days (IQR 1.5–3 days), and the mean follow-up time was 1.0 year (range 1 month to 2.86 years). Functional outcomes are similar to those of open callosotomy, with the greatest effect in patients with a significant component of drop attacks in their seizure semiology. One patient achieved an Engel class II outcome after anterior two-thirds callosotomy resulting in only rare seizures at the 18-month follow-up. Four others were in Engel class III and 5 were Engel class IV. Hemorrhage occurred in 1 patient at the time of removal of the laser fiber, which was placed through the bone flap of a prior open partial callosotomy.CONCLUSIONSLITT appears to be a safe and effective means for performing corpus callosotomy. Additional data are needed to confirm equipoise between open craniotomy and LITT for corpus callosotomy.

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Section: Review Of the Literature To Datementioning

confidence: 99%

Corpus callosotomy performed with laser interstitial thermal therapy

Roland

Akbari

Salehi

et al. 2021

Journal of Neurosurgery

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“…17 Laser interstitial thermal therapy (LITT) is a minimally invasive surgical technique that has shown favorable outcomes in patients with a variety of brain lesions 16,18,26,27,[32][33][34] and has shown favorable outcomes in patients with epilepsy. 1,19,20,35,37,40 Following FDA clearance of two major LITT systems in 2007 (Visualase System, Medtronic Inc.) and 2009 (NeuroBlate System, Monteris Medical Corp.), this technology was first used to treat mesial TLE (mTLE) in 2010 and has been rapidly adapted as one of the neurosurgical tools to manage patients with RE. 4,5,19,22,31,36,40 A recent multicenter study of 234 patients who underwent LITT for mTLE showed that 58% of patients achieved an Engel class I outcome at both 1 and 2 years following LITT.…”

mentioning

confidence: 99%

Inverse national trends of laser interstitial thermal therapy and open surgical procedures for refractory epilepsy: a Nationwide Inpatient Sample–based propensity score matching analysis

Sharma¹,

Ball²,

Alhourani³

et al. 2020

Neurosurgical Focus

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OBJECTIVESurgery for medically refractory epilepsy (RE) is an underutilized treatment modality, despite its efficacy. Laser interstitial thermal therapy (LITT), which is minimally invasive, is increasingly being utilized for a variety of brain lesions and offers comparable seizure outcomes. The aim of this study was to report the national trends of open surgical procedures for RE with the advent of LITT.METHODSData were extracted using the ICD-9/10 codes from the Nationwide Inpatient Sample (NIS, 2012–2016) in this retrospective study. Patients with a primary diagnosis of RE who underwent either open surgeries (lobectomy, partial lobectomy, and amygdalohippocampectomy) or LITT were included. Patient demographics, complications, hospital length of stay (LOS), discharge disposition, and index hospitalization costs were analyzed. Propensity score matching (PSM) was used to analyze outcomes.RESULTSA cohort of 128,525 in-hospital patients with RE was included and 5.5% (n = 7045) of these patients underwent either open surgical procedures (94.3%) or LITT (5.7%). LITT is increasingly being performed at a rate of 1.09 per 1000 epilepsy admissions/year, while open surgical procedures are decreasing at a rate of 10.4/1000 cases/year. The majority of procedures were elective (92%) and were performed at large-bed-size hospitals (86%). All LITT procedures were performed at teaching facilities and the majority were performed in the South (37%) and West (30%) regions. The median LOS was 1 day for the LITT cohort and 4 days for the open cohort. Index hospitalization charges were significantly lower following LITT compared to open procedures ($108,332 for LITT vs $124,012 for open surgery, p < 0.0001). LITT was associated with shorter median LOS, high likelihood of discharge home, and lower median index hospitalization charges compared to open procedures for RE on PSM analysis.CONCLUSIONSLITT is increasingly being performed in favor of open surgical procedures. LITT is associated with a shorter LOS, a higher likelihood of being discharged home, and lower index hospitalization charges compared to open procedures. LITT is a safe treatment modality in carefully selected patients with RE and offers an opportunity to increase the utilization of surgical treatment in patients who may be opposed to open surgery or have contraindications that preclude open surgery.

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“…described the use of LITT for corpus callosotomy. 14,15,[19][20][21][22][23][24] The present study constitutes the largest case series of SLACC, with seizure outcomes similar to open callosotomy in 10 patients with LGS.…”

Section: Discussionmentioning

confidence: 71%

“…24 Ball et al and Karsy et al presented case reports of SLACC with favorable outcomes. 19,22 Postoperative discomfort after SLACC was minimal. Postoperative length of hospital stay was <24 hours in eight (80%) of 10 patients.…”

Section: Slacc Versus Open Callosotomymentioning

confidence: 96%

Stereotactic laser anterior corpus callosotomy for Lennox‐Gastaut syndrome

et al. 2020

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Objective: Corpus callosotomy is an effective palliative treatment for drug-resistant Lennox-Gastaut syndrome (LGS). Laser interstitial thermal therapy has been increasingly used in the treatment of epilepsy. Here, we assess the safety and effectiveness of minimally invasive stereotactic laser anterior corpus callosotomy (SLACC) for drop attacks in LGS. Methods: We reviewed sequential cases of patients with medically intractable LGS who underwent SLACC using a two-cannula technique between November 2014 and July 2019. Pre-and postoperative magnetic resonance imaging was used to measure the anteroposterior length of callosal ablation (contrast-enhancing lesion) and estimated disconnection (gap in tract projections on diffusion tensor imaging). Patients were followed longitudinally to assess clinical outcomes. Results: Ten patients were included in this study. The median age was 33 (range = 11-52) years, median duration of epilepsy was 26 (range = 10-49) years, and median duration of postoperative follow-up was 19 (range = 6-40) months. In the anteroposterior direction, 53 ± 7% (mean ± SD) of the corpus callosum was ablated and 62 ± 19% of the corpus callosum was estimated to be disconnected. Six (60%) of 10 patients achieved >80% seizure reduction, two (20%) of whom became seizure-free. Eight (80%) patients had >80% reduction in drop attacks, five (50%) of whom became free of drop attacks. Three patients subsequently underwent laser posterior callosotomy with further improvement in drop attacks and/or overall seizure frequency.One patient had an asymptomatic intracerebral hemorrhage along the cannula tract.One patient developed significant aggression after becoming seizure-free. Significance: Seizure outcomes following SLACC were comparable to previously reported outcomes of open callosotomy, with reasonable safety profile. SLACC appears to be an effective alternative to open anterior corpus callosotomy with minimal postoperative discomfort and a short recovery period.

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Anterior Corpus Callosotomy Using Laser Interstitial Thermal Therapy for Refractory Epilepsy

Cited by 34 publications

References 20 publications

Corpus callosotomy performed with laser interstitial thermal therapy

Corpus callosotomy performed with laser interstitial thermal therapy

Inverse national trends of laser interstitial thermal therapy and open surgical procedures for refractory epilepsy: a Nationwide Inpatient Sample–based propensity score matching analysis

Stereotactic laser anterior corpus callosotomy for Lennox‐Gastaut syndrome

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