Carbon dioxide laser for corpus callosotomy in the pediatric population

Choudhri, Omar; Lober, Robert M.; Camara-Quintana, Joaquin; Yeom, Kristen W.; Guzman, Raphael; Edwards, Michael S. B.

doi:10.3171/2014.10.peds13498

Cited by 20 publications

(16 citation statements)

References 34 publications

(35 reference statements)

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“…42 Less invasive methods in which endoscopy and CO 2 lasers were used have also been completed successfully, but these approaches also require an interhemispheric approach with its associated risks. 8,13,19 Radiosurgical approaches to CC performed using stereotactic radiosurgery (SRS) involve even lower levels of invasiveness than LITT; however, la-tency of effect and potential risks of radiation necrosis are notable disadvantages. 11,14 Other radiosurgical approaches including focused ultrasound and radiofrequency ablation have not been reported.…”

Section: Discussionmentioning

confidence: 99%

Validation of corpus callosotomy after laser interstitial thermal therapy: a multimodal approach

Lehner

Yeagle

Klimaj

et al. 2019

Journal of Neurosurgery

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ObjectiveDisconnection of the cerebral hemispheres by corpus callosotomy (CC) is an established means to palliate refractory generalized epilepsy. Laser interstitial thermal therapy (LITT) is gaining acceptance as a minimally invasive approach to treating epilepsy, but this method has not been evaluated in clinical series using established methodologies to assess connectivity. The goal in this study was to demonstrate the safety and feasibility of MRI-guided LITT for CC and to assess disconnection by using electrophysiology- and imaging-based methods.MethodsRetrospective chart and imaging review was performed in 5 patients undergoing LITT callosotomy at a single center. Diffusion tensor imaging and resting functional MRI were performed in all patients to assess anatomical and functional connectivity. In 3 patients undergoing simultaneous intracranial electroencephalography monitoring, corticocortical evoked potentials and resting electrocorticography were used to assess electrophysiological correlates.ResultsAll patients had generalized or multifocal seizure onsets. Three patients with preoperative evidence for possible lateralization underwent stereoelectroencephalography depth electrode implantation during the perioperative period. LITT ablation of the anterior corpus callosum was completed in a single procedure in 4 patients. One complication involving misplaced devices required a second procedure. Adequacy of the anterior callosotomy was confirmed using contrast-enhanced MRI and diffusion tensor imaging. Resting functional MRI, corticocortical evoked potentials, and resting electrocorticography demonstrated functional disconnection of the hemispheres. Postcallosotomy monitoring revealed lateralization of the seizures in all 3 patients with preoperatively suspected occult lateralization. Four of 5 patients experienced > 80% reduction in generalized seizure frequency. Two patients undergoing subsequent focal resection are free of clinical seizures at 2 years. One patient developed a 9-mm intraparenchymal hematoma at the site of entry and continued to have seizures after the procedure.ConclusionsMRI-guided LITT provides an effective minimally invasive alternative method for CC in the treatment of seizures associated with drop attacks, bilaterally synchronous onset, and rapid secondary generalization. The disconnection is confirmed using anatomical and functional neuroimaging and electrophysiological measures.

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Section: Discussionmentioning

confidence: 99%

Validation of corpus callosotomy after laser interstitial thermal therapy: a multimodal approach

Lehner

Yeagle

Klimaj

et al. 2019

Journal of Neurosurgery

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“…In 2015, Choudhri et al [13] described a similar technique to complete 8 callosotomies in 6 pediatric patients, resulting in either complete resolution or an improvement in the frequency of drop attacks in all patients; no complications were noted in this study.…”

Section: Discussionmentioning

confidence: 90%

Anterior Corpus Callosotomy Using Laser Interstitial Thermal Therapy for Refractory Epilepsy

Ball

Sharma

White

2018

Stereotact Funct Neurosurg

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Corpus callosotomy is a viable treatment for patients with refractory generalized or multifocal epilepsy, particularly those who have drop attacks. Laser interstitial thermal therapy (LITT) is a minimally invasive surgical option for various intracranial lesions. In this report, we present a 2-trajectory thermal ablation using the NeuroBlate® system (Monteris Medical, MN, USA) for an anterior two-thirds callosotomy in a patient with refractory epilepsy and frequent drop attacks. Adequate ablation of the corpus callosum was confirmed by MRI during the procedure. At the 1-month follow-up, the frequency had decreased from multiple seizures per day to only 3 over the course of 1 month. In addition, he had not suffered any drop attacks or tonic-clonic movements since the procedure. Five months after surgery, seizures had decreased to 1 per month with no drop attacks or loss of consciousness, consistent with an Engel class II outcome. In conclusion, LITT ablation of the corpus callosum is a safe, feasible, and minimally invasive treatment option for patients with refractory epilepsy, and it may be an attractive alternative for patients unwilling or unable to undergo open surgery.

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“…1,15,27,33 Its use has also been reported in the treatment of various types of neurosurgical pathologies, including intracranial tumors, vascular malformations, laminectomy, cord untethering, and corpus callosotomy. 4,[6][7][8]18 A variety of fibers are available for different applications, with the Beam Path Neuro-L fiber developed specifically for neurosurgery.…”

Section: Discussionmentioning

confidence: 99%

Use of a flexible hollow-core carbon dioxide laser for microsurgical resection of vestibular schwannomas

Schwartz

Leković

2018

Neurosurgical Focus

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OBJECTIVEThe CO2 laser has been used on an intermittent basis in the microsurgical resection of brain tumors for decades. These lasers were typically cumbersome to use due to the need for a large, bulky design since infrared light cannot be transmitted via fiber-optic cables. Development of the OmniGuide cable, which is hollow and lined with an omnidirectional dielectric mirror, has facilitated the reintroduction of the CO2 laser in surgical use in a number of fields. This device allows for handheld use of the CO2 laser in a much more ergonomically favorable configuration, holding promise for microneurosurgical applications. This device was introduced into the authors’ practice for use in the microsurgical resection of skull base tumors, including vestibular schwannomas.METHODSThe authors reviewed the initial 41 vestibular schwannomas that were treated using the OmniGuide CO2 laser during an 8-month period from March 2010 to October 2010. The laser was used for all large tumors, and select medium-sized tumors were treated via both the translabyrinthine and retrosigmoid approaches. The estimated time of tumor resection and estimated blood loss were obtained from operating room records. Data regarding complications, facial nerve and hearing outcomes, and further treatment were collected from hospital and clinic records, MRI reports, and direct review of MR images. Time of resection and blood loss were compared to a control group (n = 18) who underwent surgery just prior to use of the laser.RESULTSA total of 41 patients with vestibular schwannomas were surgically treated. The median estimated time of tumor resection was 150 minutes, and the median estimated blood loss was 300 ml. The only operative complication was 1 CSF leak. Thirty-eight patients had normal facial nerve function at late follow-up. The median MRI follow-up was 52 months, and, during that time, only 1 patient required further treatment for regrowth of a residual tumor.CONCLUSIONSThe OmniGuide CO2 laser is a useful adjunct in the resection of large vestibular schwannomas. This device was used primarily as a cutting tool rather than for tumor vaporization, and it was found to be of most use for very large and/or firm tumors. There were no laser-associated complications, and the results compared favorably to earlier reports of vestibular schwannoma resection.

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Carbon dioxide laser for corpus callosotomy in the pediatric population

Cited by 20 publications

References 34 publications

Validation of corpus callosotomy after laser interstitial thermal therapy: a multimodal approach

Validation of corpus callosotomy after laser interstitial thermal therapy: a multimodal approach

Anterior Corpus Callosotomy Using Laser Interstitial Thermal Therapy for Refractory Epilepsy

Use of a flexible hollow-core carbon dioxide laser for microsurgical resection of vestibular schwannomas

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