Laser ablation for corpus callosotomy: Systematic review and pooled analysis

Awad, Ahmed J.; Kaiser, Kristen N.

doi:10.1016/j.seizure.2022.02.002

Cited by 10 publications

(12 citation statements)

References 15 publications

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“…Introduction: Bowing of the Fourth Ventricle, defined as a Fourth Ventricular Roof Angle (FVRA) > 65 degrees, was recently reported to predict brainstem dysfunction in a mixed series of adult and pediatric Chiari-I malformation (CM-I) patients at a single center. 1 This novel finding has not been validated elsewhere.…”

Section: Discussionmentioning

confidence: 88%

46th Annual Meeting The American Society of Pediatric Neurosurgeons

2023

Journal of Neurosurgery: Pediatrics

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Institutions:(1) Divisions of Neurosurgery, (2) Nephrology and (3) Neonatology, (4) and the Children's Mercy Bioethics Center4 Children's Mercy Kansas City Kansas City, MO All authors have no relevant disclosures. Introduction:Informed consent is a pillar of modern bioethics and is supported by numerous ethical principles, including beneficence, respect for persons and personal autonomy. It is also now a legal requirement for most research and medical care. Its elements include that the patient understands the risks/benefits, that "relevant" information has been disclosed to the patient and that the patient has the ability to make a voluntary decision to proceed. Methods:The advent of maternal-fetal medicine has presented unique challenges, starting with the notion of two patients. Furthermore, much of the care offered is at the leading edge of innovation. The impact on informed consent is broad, including uneven distribution of risks, tangible benefit for one patient only, fetal benefit being highest in lethal conditions, the fetus cannot consent and has poorly defined rights (up until delivery) and the father's rights remain unclear. Results:The process of fetal repair of myelomeningocele has passed through the stages of innovation/experiment, research and ultimately to "standard of care" in <25 years. As a non-lethal condition, the risk/benefit approach is much harder to define, particularly as the risks can evolve with the growth of the procedure. It is proposed that the development of the procedures must be based on the hope of reducing disability, with consent being based on the principles of autonomy and beneficence for the mother, but on the beneficence principle only for the baby. Conclusion:An example of a less than ideal informed consent will be presented, and the historical lessons learned from the development of caesarian section will also be reviewed.

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Section: Discussionmentioning

confidence: 88%

46th Annual Meeting The American Society of Pediatric Neurosurgeons

2023

Journal of Neurosurgery: Pediatrics

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“…27,28 Seizure outcomes with laser callosotomy are comparable to those of open corpus callosotomy. 25,40 Two of 3 patients presented here had significant improvement in their seizures after laser callosotomy, with 1 patient having complete resolution of atonic seizures. The patient with the least complete disconnection (89%) unfortunately did not experience significant improvement.…”

Section: Observationsmentioning

confidence: 78%

“…A recent systematic review of 40 patients with atonic seizures (39 partial or completion callosotomies, 1 complete) from 10 reports demonstrated complete freedom from atonic seizures in 52.8% of cases. 40 Caruso et al 25 compared open corpus callosotomy with laser callosotomy and found both experienced reduction of atonic seizure frequency postoperatively, whereas the group that underwent LITT had a shorter intensive care LOS and lower estimated blood loss and trended toward having a shorter overall LOS.…”

Section: Discussionmentioning

confidence: 99%

Magnetic resonance imaging–guided laser interstitial thermal therapy for complete corpus callosotomy: technique and 1-year outcomes. Patient series

Best

Kim

Lew

2022

Journal of Neurosurgery: Case Lessons

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BACKGROUND Magnetic resonance imaging (MRI)-guided stereotactic laser interstitial thermal therapy (LITT) is a minimally invasive technique that has been described for the treatment of certain forms of epilepsy through partial or complete callosotomy, with few cases describing single-stage complete LITT callosotomy. The authors aimed to demonstrate this technique’s feasibility and efficacy through description of the technique and 1-year outcomes in 3 cases of single-stage complete LITT callosotomy in patients with anatomically normal corpa callosa (CCs). OBSERVATIONS The patients were aged 14–27 years and experienced atonic seizures. Completeness of callosotomy was determined from MRI scans obtained >3 months after LITT procedures. The estimated ablations of the CC were 94%, 89%, and 100%, respectively. The second patient had a catheter breach the lateral ventricle, resulting in the lowest estimated percentage of ablation in this series (89%), with minimal atonic seizure reduction. The first patient had significant reduction in atonic seizure frequency, and the third patient had complete resolution of atonic seizures. None of the patients experienced any long-term complications. Intensive care length of stay was 1 night for each patient, and total length of stay was between 2 and 7 nights. Postoperative follow-up was between 14 and 18 months. LESSONS Complete laser callosotomy is achievable and is a safe alternative to microsurgical or endoscopic approaches.

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“… 24 Furthermore, LITT is also a technique for callosotomy in cases of primary or secondarily generalized epilepsy. 25 As a treatment option that offered good probability of seizure freedom with potentially lower functional morbidity than resection, LITT was an appropriate treatment for this rare presentation of ME. As a case report, the treatment approach and results described here do not necessarily generalize to the surgical treatment of ME or other presentations of MTLE.…”

Section: Discussionmentioning

confidence: 99%

Laser ablative treatment of musicogenic epilepsy arising from dominant mesial temporal lobe: illustrative case

Park¹,

Sinha

Southwell³

2022

Journal of Neurosurgery: Case Lessons

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BACKGROUND Musicogenic epilepsy (ME) is a rare reflex epilepsy in which seizures are triggered by musical stimuli. Prior descriptions of ME have suggested localization to the nondominant temporal lobe, primarily in neocortex. Although resection has been described as a treatment for ME, other surgical modalities, such as laser ablation, may effectively disrupt seizure networks in ME while incurring comparatively lower risks of morbidity. The authors described the use of laser ablation to treat ME arising from the dominant mesial temporal structures. OBSERVATIONS A 37-year-old woman with a 15-year history of drug-resistant ME was referred for surgical evaluation. Her seizures were triggered by specific musical content and involved behavioral arrest, repetitive swallowing motions, and word incomprehension. Diagnostic studies, including magnetic resonance imaging, single-photon emission computed tomography, magnetoencephalography, Wada testing, and stereoelectroencephalography, indicated seizure onset in the left (dominant) mesial temporal lobe. Laser interstitial thermal therapy was used to ablate the left mesial seizure onset zone. The patient was discharged on postoperative day two. At 18-month follow-up, she was seizure-free with no posttreatment neurological deficits. LESSONS Laser ablation can be an effective treatment option for well-localized forms of ME, particularly when seizures originate from the dominant mesial temporal lobe.

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Laser ablation for corpus callosotomy: Systematic review and pooled analysis

Cited by 10 publications

References 15 publications

46th Annual Meeting The American Society of Pediatric Neurosurgeons

46th Annual Meeting The American Society of Pediatric Neurosurgeons

Magnetic resonance imaging–guided laser interstitial thermal therapy for complete corpus callosotomy: technique and 1-year outcomes. Patient series

Laser ablative treatment of musicogenic epilepsy arising from dominant mesial temporal lobe: illustrative case

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