Corpus Callosotomy with the CO&lt;sub&gt;2&lt;/sub&gt; Laser Suction Device: A Technical Note

Falowski, Steven; Byrne, Richard W.

doi:10.1159/000336337

Cited by 18 publications

(8 citation statements)

References 21 publications

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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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“…18,32 For these reasons, the CO 2 laser has proven useful in the resection of lesions located in eloquent regions of the nervous system, including lesions in the speech area, brainstem tumors, cavernomas, intramedullary spinal cord tumors, craniopharyngiomas adherent to the hypothalamus, and tumors involv-ing cranial nerves, 24,27 as well as for corpus callosotomies. 33 We have found the precision of the CO 2 laser useful in the disconnection procedures for epilepsy surgery, as well. One limitation observed has been the inability of the CO 2 laser to penetrate calcified lesions.…”

Section: Discussionmentioning

confidence: 97%

Application of Novel CO2 Laser-Suction Device

et al. 2013

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Background Development of the flexible CO2 fiber has presented new opportunities for the use of precision laser cutting in cranial procedures. The efficacy of the CO2 scalpel is further enhanced by combining it with a fluid removal suction capability. Objectives We report our experience with a novel CO2 laser-suction device. Methods The novel laser-suction device was designed in conjunction with OmniGuide Inc. (Cambridge, Massachusetts, USA). We performed a case review of its use in firm tumors that were resistant to resection by bipolar, suction, and ultrasonic aspirator. Results The laser-suction device was applied in three tumors where resection with ultrasonic aspiration failed. Tumor resection using the laser-suction device was successful in all three cases. There were no complications related to the laser-suction device. There were no instances of intraoperative device malfunction. Discussion The CO2 laser combined with suction is a useful instrument for resection of firm tumors that prove to be resistant to ultrasonic aspiration. We also find it to be useful in settings where precise tissue incisions are desired with minimal manipulation. In our experience, the surgical efficiency of the CO2 laser is improved by the laser-suction device. This device allows the surgeon to utilize a suction device and laser in a single hand and enables concurrent use of bipolar electrocautery without repeated instrument changes.

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“…Falowski and Byrne [12] first described the use of a carbon dioxide laser in place of bipolar electrocautery to lesion the corpus callosum in open surgery in 2 patients with generalized epilepsy. 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: 99%

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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Corpus Callosotomy with the CO<sub>2</sub> Laser Suction Device: A Technical Note

Cited by 18 publications

References 21 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

Application of Novel CO2 Laser-Suction Device

Anterior Corpus Callosotomy Using Laser Interstitial Thermal Therapy for Refractory Epilepsy

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