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

Abstract

<b><i>Background:</i></b> 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. <b><i>Clinical Presentations:</i></b> 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. <b><i>Results:</i></b> 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. <b><i>Conclusion:</i></b> Our experience demonstrates that robotic guidance systems can safely and effectively be adapted for minimally invasive LITT corpus callosotomy.

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

“…The calculated extent of ablation in this series is similar to that in other cases reported and is loosely correlated with outcome. 27 , 28 …”

“…[17][18][19][20][21][22][23][24] There are few reports of complete corpus callosotomy using LITT as a standalone procedure. [25][26][27][28] This study aimed to further demonstrate the efficacy and safety of complete corpus callosotomy using LITT and is the first to include multiple complete callosotomies with normal callosal anatomy, detailed technical description, follow-up beyond 1 year, and a quantitative assessment of the extent of ablation based on delayed imaging.…”

“…The calculated extent of ablation in this series is similar to that in other cases reported and is loosely correlated with outcome. 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.…”

“…Other temporary neurological deficits were reported in the literature, including truncal ataxia and imbalance, whereas 1 patient experienced permanent dysarthria after complete LITT callosotomy. [26][27][28] Five patients experienced intraparenchymal hemorrhage associated with LITT for corpus callosotomy. 20,27,44,45 Lessons Complete laser callosotomy is achievable and is a safe alternative to microsurgical or endoscopic approaches, with seemingly similar seizure outcomes.…”

“…17 Additional reports on using LITT for corpus callosotomy provide insight into efficacy and outcomes of the technique. [25][26][27][28] Although there is growing evidence regarding the safety and efficacy of LITT for anterior two-thirds corpus callosotomy and completion callosotomy, there is a paucity of literature detailing complete callosotomies performed with LITT in patients with anatomically normal corpa callosa (CCs). Here, we present 3 cases of complete MRI-guided LITT corpus callosotomy with details on surgical strategy, quantitative assessment of completeness of the callosotomy using delayed imaging, and >1-year clinical outcomes.…”