Corpus callosotomy performed with laser interstitial thermal therapy

Roland, Jarod L.; Akbari, S. Hassan A.; Salehi, Afshin; Smyth, Matthew D.

doi:10.3171/2019.9.jns191769

Cited by 25 publications

(31 citation statements)

References 38 publications

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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: 72%

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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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Section: Discussionmentioning

confidence: 72%

“…They found complete or near-complete freedom from targeted seizures in one of five patients, significant target seizure reduction in two, and minimal benefit in two. 24 Ball et al and Karsy et al presented case reports of SLACC with favorable outcomes. 19,22 Postoperative discomfort after SLACC was minimal.…”

Section: Slacc Versus Open Callosotomymentioning

confidence: 99%

Stereotactic laser anterior corpus callosotomy for Lennox‐Gastaut syndrome

et al. 2020

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“…Corpus callosotomy is performed either as an anterior two-thirds disconnection of corpus callosum or as a complete disconnection [158], generally performed either through an open approach via a standard craniotomy with the aid of an operating microscope, or alternatively via a mini-craniotomy with endoscope assistance, with the latter having the benefit of a smaller incision, minimised brain retraction, and lower postoperative pain [158]. More recently, a minimally invasive method-magnetic resonance imaging (MRI)-guided stereotactic laser interstitial thermal therapy (LITT)-has shown promising results in case reports [159][160][161][162][163][164][165][166][167]. In the largest study to date, investigating MRI-guided stereotactic laser anterior corpus callosotomy (SLACC) in 10 patients with LGS (median age 33 years, range 11-52 years), eight (80%) patients had > 80% reduction in drop attacks, of whom five (50%) became free of drop attacks, and six (60%) achieved > 80% seizure reduction, with two (20%) becoming seizure free [167].…”

Section: Corpus Callosotomymentioning

confidence: 99%

Expanding the Treatment Landscape for Lennox-Gastaut Syndrome: Current and Future Strategies

Strzelczyk

Schubert‐Bast

2021

CNS Drugs

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Lennox-Gastaut syndrome (LGS), a childhood-onset severe developmental and epileptic encephalopathy (DEE), is an entity that encompasses a heterogenous group of aetiologies, with no single genetic cause. It is characterised by multiple seizure types, an abnormal EEG with generalised slow spike and wave discharges and cognitive impairment, associated with high morbidity and profound effects on the quality of life of patients and their families. Drug-refractory seizures are a hallmark and treatment is further complicated by its multiple morbidities, which evolve over the patient’s lifetime. This review provides a comprehensive overview of the current and future options for the treatment of seizures associated with LGS. Six treatments are specifically indicated as adjunct therapies for the treatment of seizures associated with LGS in the US: lamotrigine, clobazam, rufinamide, topiramate, felbamate and most recently cannabidiol. These therapies have demonstrated reductions in drop seizures in 15%–68% of patients across trials, with responder rates (≥ 50% reduction in drop seizures) of 37%–78%. Valproate is still the preferred first-line treatment, generally in combination with lamotrigine or clobazam. Other treatments frequently used off-label include the broad spectrum anti-epileptic drugs (AED) levetiracetam, zonisamide and perampanel, while recent evidence from observational studies has indicated that a newer AED, the levetiracetam analogue brivaracetam, may be effective and well tolerated in LGS patients. Other treatments in clinical development include fenfluramine in late phase III, perampanel, soticlestat–OV953/TAK-953, carisbamate and ganaxolone. Non-pharmacologic interventions include the ketogenic diet, vagus nerve stimulation and surgical interventions; these are also expanding, with the potential for less invasive techniques for corpus callosotomy that have promise for reducing complications. However, despite these advancements, patients continue to experience a significant burden. Because LGS is not a single entity, tailoring of treatment is needed as opposed to a ‘one size fits all’ approach. Further research is needed into the underlying aetiologies and pathophysiology of LGS, together with advancements in treatments that encompass the spectrum of seizures associated with this complex syndrome.

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“…Stereotactic magnetic resonance (MR) thermometry-guided laser corpus callosotomy uses MR thermometry to provide monitoring of treatment volumes, tissue heating, and temperature safety cutoffs [8, 11, 12]. Prior reports of LITT for anterior corpus callosotomy employed MR imaging-guided stereotactic techniques with a traditional head frame [7, 13-17]. Robotic-assisted neurosurgery is increasingly popular due to its potential to decrease human error, reduce operative times, and not sacrifice procedural precision [18].…”

Section: Background and Importancementioning

confidence: 99%

Using a Robotic-Assisted Approach for Stereotactic Laser Ablation Corpus Callosotomy: A Technical Report

Ung

Kahn

Hirt

et al. 2021

Stereotact Funct Neurosurg

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Background: Corpus callosotomy for medically intractable epilepsy is an effective ablative procedure traditionally achieved using either standard open craniotomy or with less-invasive approaches. Advances in robotic-assisted stereotactic guidance for neurosurgery can be applied for LITT for corpus callosotomy. Clinical Presentations: Two patients were included in this study. One was a 25-year-old female patient with extensive bi-hemispheric malformations of cortical development and medically refractory epilepsy, and the other was an 18-year-old male with medically refractory epilepsy and atonic seizures, who underwent a complete corpus callosotomy using robotic-assisted stereotactic guidance for LITT. Results: Both patients underwent successful intended corpus callosotomy with volumetric analysis demonstrating a length disconnection of 74% and a volume disconnection of 55% for patient 1 and a length disconnection of 83% and a volume disconnection of 33% for patient 2. Postoperatively, both patients had clinical reductions in seizure. Conclusion: Our experience demonstrates that robotic guidance systems can safely and effectively be adapted for minimally invasive LITT corpus callosotomy.

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Corpus callosotomy performed with laser interstitial thermal therapy

Cited by 25 publications

References 38 publications

Stereotactic laser anterior corpus callosotomy for Lennox‐Gastaut syndrome

Stereotactic laser anterior corpus callosotomy for Lennox‐Gastaut syndrome

Expanding the Treatment Landscape for Lennox-Gastaut Syndrome: Current and Future Strategies

Using a Robotic-Assisted Approach for Stereotactic Laser Ablation Corpus Callosotomy: A Technical Report

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