Stereotactic laser ablation for nonlesional cingulate epilepsy: case report

Marashly, Ahmad; Loman, Michelle M.; Lew, Sean M.

doi:10.3171/2018.5.peds18120

Cited by 11 publications

(10 citation statements)

References 32 publications

(27 reference statements)

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“…One study that was documented as a video supplement on YouTube reported utilization of LiTT for anterior 2/3 callosotomy (using 3 trajectories/laser applicators) in a 17-year old female patient with a history of Lennox-Gastaut syndrome [37]. Two studies reported stereotactic EEG-guided laser thermotherapy in patients with MRI-nonlesional epilepsies [19,36]. Somewhat unexpectedly, two studies did not define the underlying etiology more closely for a total of 11 patients [5,31].…”

Section: Indication (Underlying Etiologies)mentioning

confidence: 99%

Laser interstitial thermotherapy (LiTT) in pediatric epilepsy surgery

Hoppe

Helmstaedter

2020

Seizure

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Laser interstitial thermotherapy (LiTT) is a novel stereotactic approach to the surgical treatment of severe drugresistant focal epilepsies. This review extends our recent general review on this topic (Hoppe et al. Laser interstitial thermotherapy [LiTT] in epilepsy surgery. Seizure 2017; 48:45-52) with a focus on children (age < 18 years). A PubMed search retrieved 25 uncontrolled case series reports that included a total of 179 pediatric patients as well as 7 review papers that specifically referred to using LiTT in pediatric epilepsy surgery (due August 31, 2018). Hypothalamic hamartomas (HH) represented the most frequent indication (64.2%) while therapeutic evidence for other more frequent etiologies underlying severe focal childhood epilepsies (e.g. focal cortical dysplasia, mesiotemporal sclerosis) is still scarce (n < 20). For the published cases, the rate of severe complications was 3.4% and the overall complication rate was 23.5%. The seizure freedom rate (Engel class 1) was 57.5% (including patients with early follow-up and repeat thermoablations). None of the studies included the systematic evaluation of the cognitive outcome. Overall, the published evidence does not yet allow a scientific or clinical judgement on the utility of LiTT for pediatric epilepsy surgery. LiTT is likely to extend the neurosurgical toolbox with regard to deep brain lesions (e.g. HH). However, in cases that are equally accessible for both approaches therapeutic superiority of LiTT over open resective surgery still remains to be demonstrated. Recommendations for controlled though non-randomized outcome studies are provided.

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Section: Indication (Underlying Etiologies)mentioning

confidence: 99%

Laser interstitial thermotherapy (LiTT) in pediatric epilepsy surgery

Hoppe

Helmstaedter

2020

Seizure

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“…20,32 It has also been applied to mesial temporal lobe epilepsy 10,11,34,36 and localized focal epilepsy. 19,37 Few studies have suggested that LITT may be effective in performing corpus callosotomy with acceptable risk and reduced surgical morbidity. Here, we pre sent our efforts in the continued innovation of less invasive neurosurgical treatment with a retrospective case series of corpus callosotomy performed with LITT in 10 patients at our institution.…”

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confidence: 99%

Corpus callosotomy performed with laser interstitial thermal therapy

Roland

Akbari

Salehi

et al. 2021

Journal of Neurosurgery

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OBJECTIVECorpus callosotomy is a palliative procedure that is effective at reducing seizure burden in patients with medically refractory epilepsy. The procedure is traditionally performed via open craniotomy with interhemispheric microdissection to divide the corpus callosum. Concerns for morbidity associated with craniotomy can be a deterrent to patients, families, and referring physicians for surgical treatment of epilepsy. Laser interstitial thermal therapy (LITT) is a less invasive procedure that has been widely adopted in neurosurgery for the treatment of tumors. In this study, the authors investigated LITT as a less invasive approach for corpus callosotomy.METHODSThe authors retrospectively reviewed all patients treated for medically refractory epilepsy by corpus callosotomy, either partial or completion, with LITT. Chart records were analyzed to summarize procedural metrics, length of stay, adverse events, seizure outcomes, and time to follow-up. In select cases, resting-state functional MRI was performed to qualitatively support effective functional disconnection of the cerebral hemispheres.RESULTSTen patients underwent 11 LITT procedures. Five patients received an anterior two-thirds LITT callosotomy as their first procedure. One patient returned after LITT partial callosotomy for completion of callosotomy by LITT. The median hospital stay was 2 days (IQR 1.5–3 days), and the mean follow-up time was 1.0 year (range 1 month to 2.86 years). Functional outcomes are similar to those of open callosotomy, with the greatest effect in patients with a significant component of drop attacks in their seizure semiology. One patient achieved an Engel class II outcome after anterior two-thirds callosotomy resulting in only rare seizures at the 18-month follow-up. Four others were in Engel class III and 5 were Engel class IV. Hemorrhage occurred in 1 patient at the time of removal of the laser fiber, which was placed through the bone flap of a prior open partial callosotomy.CONCLUSIONSLITT appears to be a safe and effective means for performing corpus callosotomy. Additional data are needed to confirm equipoise between open craniotomy and LITT for corpus callosotomy.

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“…LCA is multiple, and few solitary neoplasms were reported. To date, imaging examination cannot determine whether the lesion is benign or malignant because some other neoplasms of the spleen such as Kaposi sarcoma, [ 10 ] angiosarcoma hemangiomatosis, [ 11 ] hamartoma, [ 12 ] lymphoma, [ 13 ] hemangioendothelioma, and angiosarcoma, [ 14 , 15 ] share similar appearance to LCA. In addition, no correct diagnosis of LCA can be established before surgery.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic splenectomy for littoral cell angioma of the spleen

Zhou

Cao

et al. 2019

Medicine

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Rationale:Littoral cell angioma (LCA) is a rare primary vascular neoplasm of the spleen. It can be benign or malignant. Pathology and immunohistochemistry are the gold standards for the diagnosis of LCA. Therefore, splenectomy is recommended for the purpose of diagnosis and treatment, and subsequent follow-up is necessary. There are limited reports about LCA. Here, we present a case of a female patient with LCA undergoing laparoscopic splenectomy in order to provide clinical experience in LCA treatment.Patient concerns:A 32-year-old female attended the outpatient Department of Hepatobiliary Surgery for follow-up of hepatic hemangiomas. The patient presented with intermittent abdominal distension, which was slightly under no obvious inducement.Diagnosis:Physical examination found no signs of abdominal tenderness and rebound tenderness, and liver and spleen were impalpable. The contrast-enhanced computed tomography (CT) showed multiple space-occupying lesions in the spleen, mottled low-density lesions, multiple hypoattenuating nodules with no contrast enhancement on the arterious phase. Delayed contrast-enhanced helical CT scan displayed incomplete filling of hypodense splenic lesions.Interventions:Given that it was uncertain whether it was a benign or a malignant tumor, a laparoscopic total splenectomy was performed.Outcomes:The final pathological diagnosis was LCA. Her postsurgical course was uneventful, and no surgery-related complications were found. No signs of recurrence were observed in the 16 months after the operation.Lessons:LCA was a rare primary vascular neoplasm of the spleen, and laparoscopic splenectomy for LCA was safe and feasible, and postoperative course was uneventful. However, regular follow-up and long-time monitoring after splenectomy for LCA is recommended because of its potential malignant biological behavior.

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Stereotactic laser ablation for nonlesional cingulate epilepsy: case report

Cited by 11 publications

References 32 publications

Laser interstitial thermotherapy (LiTT) in pediatric epilepsy surgery

Laser interstitial thermotherapy (LiTT) in pediatric epilepsy surgery

Corpus callosotomy performed with laser interstitial thermal therapy

Laparoscopic splenectomy for littoral cell angioma of the spleen

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