MR-guided laser ablation for the treatment of hypothalamic hamartomas

Curry, Daniel J.; Raskin, Jeffery; Ali, Irfan; Wilfong, Angus A.

doi:10.1016/j.eplepsyres.2018.03.013

Cited by 119 publications

(78 citation statements)

References 12 publications

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“…The reoperation rate of 28.7% in the present study was relatively high. Although large cohorts for studies on laser ablation remain difficult to obtain, recent reports have shown reoperation rates for multiple ablations of 23% and 17% . These series achieved favorable GS outcomes (93% and 80% achieved final freedom from GS) comparable to the results of the present study.…”

Section: Discussionsupporting

confidence: 82%

Repeat stereotactic radiofrequency thermocoagulation in patients with hypothalamic hamartoma and seizure recurrence

2020

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Objective To evaluate the feasibility of repeat stereotactic radiofrequency thermocoagulation (re‐SRT) for patients with hypothalamic hamartoma (HH) and to clarify clinical and surgical factors for seizure outcomes. Methods Hypothalamic hamartoma patients with gelastic seizures (GSs) who underwent SRT were retrospectively reviewed. Seizure outcomes were evaluated separately for GS and other types of seizures (non‐GS). Surgical complications were compared between re‐SRT and first SRT. Clinical and surgical factors related to both seizure recurrences after first SRT and final seizure outcomes were analyzed. Results Participants comprised 150 patients (92 males; median age at surgery, 8 years; range, 1.7‐50 years). Of those, 122 (81.3%) had non‐GS. Forty‐three patients (28.7%) underwent re‐SRT. Freedom from GS was achieved by first SRT in 103 patients (68.7%), second SRT in 30/40 (67.5%), third SRT in 3/10 (30.0%), and fourth SRT in 2/3 (66.7%). Finally, 135 patients (90.0%) became GS‐free. Ninety patients (73.8%) achieved non‐GS freedom, with first SRT in all except one case. Transient complications were more frequent with first SRT (118/150, 78.7%) than re‐SRT (35/56, 62.5%), whereas persistent complications were more frequent with re‐SRT (7/56, 12.5%) than with first SRT (3/150, 2.0%). Multivariate analyses revealed only younger age at surgery (≤1 year) as related to GS recurrence after first SRT, with no variables affecting final GS outcomes. Meanwhile, seizure type (tonic seizure), intellectual disability, and genetic syndromes were significant factors for both non‐GS recurrence and final outcomes. Multiple previous treatments were significantly related to final non‐GS outcomes as well. Size and subtype of HH and surgical factors were unrelated to seizure outcomes. Significance Repeat stereotactic radiofrequency thermocoagulation provides potential opportunities to achieve freedom from recurrent GS, albeit with increased risks of persistent complications. Non‐GS and intellectual disability could offer early surgical indications, and repeated ineffective treatments should be avoided.

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Section: Discussionsupporting

confidence: 82%

Repeat stereotactic radiofrequency thermocoagulation in patients with hypothalamic hamartoma and seizure recurrence

2020

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“…The largest case series published thus far included 71 patients. Freedom from gelastic seizures after single or multiple laser ablations was achieved in 93% of these patients [151]. Another case series of 18 patients reported rates of gelastic and nongelastic seizure freedom of 81% and 56%, respectively [75].…”

Section: Hypothalamic Hamartomamentioning

confidence: 97%

Ablative brain surgery: an overview

Franzini

Moosa

Servello

et al. 2019

International Journal of Hyperthermia

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Background: Ablative therapies have been used for the treatment of neurological disorders for many years. They have been used both for creating therapeutic lesions within dysfunctional brain circuits and to destroy intracranial tumors and space-occupying masses. Despite the introduction of new effective drugs and neuromodulative techniques, which became more popular and subsequently caused brain ablation techniques to fall out favor, recent technological advances have led to the resurgence of lesioning with an improved safety profile. Currently, the four main ablative techniques that are used for ablative brain surgery are radiofrequency thermoablation, stereotactic radiosurgery, laser interstitial thermal therapy and magnetic resonance-guided focused ultrasound thermal ablation. Object: To review the physical principles underlying brain ablative therapies and to describe their use for neurological disorders. Methods: The literature regarding the neurosurgical applications of brain ablative therapies has been reviewed. Results: Ablative treatments have been used for several neurological disorders, including movement disorders, psychiatric disorders, chronic pain, drug-resistant epilepsy and brain tumors. Conclusions: There are several ongoing efforts to use novel ablative therapies directed towards the brain. The recent development of techniques that allow for precise targeting, accurate delivery of thermal doses and real-time visualization of induced tissue damage during the procedure have resulted in novel techniques for cerebral ablation such as magnetic resonance-guided focused ultrasound or laser interstitial thermal therapy. However, older techniques such as radiofrequency thermal ablation or stereotactic radiosurgery still have a pivotal role in the management of a variety of neurological disorders.

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“…The best evidence supporting the efficacy of LITT to treat patients with epilepsy with curative intent comes from the ablation of structurally well‐defined targets, including hypothalamic hamartoma and mesial temporal sclerosis 19‐21 . As experience increases, LITT is also being used to treat a growing list of epileptogenic substrates, including focal cortical dysplasia (FCD), cavernous malformation, and lesions in challenging anatomic locations such as the insula and functionally eloquent cortex 22‐24 .…”

Section: Introductionmentioning

confidence: 99%

“…Hypothalamic hamartoma (HH) may be diagnosed by MRI with high accuracy without the need for histologic verification. Open and endoscopic surgical disconnection were associated with high morbidity and moderate efficacy 19 . LITT was introduced as a minimally invasive surgical option to treat HH and was rapidly adopted as the standard surgical technique for patients with HH in some centers (Figure 2).…”

Section: Introductionmentioning

confidence: 99%

“…The rates of memory and endocrine complications observed were much lower than those published for open craniotomy and endoscopic approaches. This series encompassed the evolution of a new surgical technique through experience over time, and refinements included decreasing low‐temperature safety limit cutoffs and placing these heat constraints further away from normal structures to minimize the risk of thermal injury 19 . There is no study demonstrating that LITT would be superior to other stereotactic disconnection techniques, such as radiofrequency ablation, although results with LITT appear to be superior to those obtained using open techniques.…”

Section: Introductionmentioning

confidence: 99%

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How technology is driving the landscape of epilepsy surgery

et al. 2020

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This article emphasizes the role of the technological progress in changing the landscape of epilepsy surgery and provides a critical appraisal of robotic applications, laser interstitial thermal therapy, intraoperative imaging, wireless recording, new neuromodulation techniques, and high-intensity focused ultrasound. Specifically, (a) it relativizes the current hype in using robots for stereo-electroencephalography (SEEG) to increase the accuracy of depth electrode placement and save operating time; (b) discusses the drawback of laser interstitial thermal therapy (LITT) when it comes to the need for adequate histopathologic specimen and the fact that the concept of stereotactic disconnection is not new; (c) addresses the ratio between the benefits and expenditure of using intraoperative magnetic resonance imaging (MRI), that is, the high technical and personnel expertise needed that might restrict its use to centers with a high case load, including those unrelated to epilepsy; (d) soberly reviews the advantages, disadvantages, and future potentials of neuromodulation techniques with special emphasis on the differences between closed and open-loop systems; and (e) provides a critical outlook on the clinical implications of focused ultrasound, wireless recording, and multipurpose electrodes that are already on the horizon. This outlook shows that although current ultrasonic systems do have some limitations in delivering the acoustic energy, further advance of this technique may lead to novel treatment paradigms. Furthermore, it highlights that new data streams from multipurpose electrodes and wireless transmission of intracranial recordings will become available soon once some critical developments will be achieved such as electrode fidelity, data processing and storage, heat conduction as well as rechargeable technology. A better understanding of modern epilepsy surgery will help to demystify epilepsy surgery for the patients and the treating physicians and thereby reduce the surgical treatment gap. K E Y W O R D Sepilepsy surgery, high-intensity focused ultrasound, intraoperative MRI, laser ablation, neuromodulation, robots 842 |

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MR-guided laser ablation for the treatment of hypothalamic hamartomas

Cited by 119 publications

References 12 publications

Repeat stereotactic radiofrequency thermocoagulation in patients with hypothalamic hamartoma and seizure recurrence

Repeat stereotactic radiofrequency thermocoagulation in patients with hypothalamic hamartoma and seizure recurrence

Ablative brain surgery: an overview

How technology is driving the landscape of epilepsy surgery

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