Single and staged laser interstitial thermal therapy ablation for cortical tubers causing refractory epilepsy in pediatric patients

Abstract

OBJECTIVE Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) is a novel, minimally invasive treatment for the surgical treatment of epilepsy. In this paper, the authors report on clinical outcomes for a series of pediatric patients with tuberous sclerosis complex (TSC) and medication-refractory epileptogenic cortical tubers. METHODS A retrospective chart review was performed at SUNY Upstate Golisano Children's Hospital in Syracuse, New York. The authors included all cases involving pediatric patients (< 18 years) who underwent MRgLITT for ablation of epileptogenic cortical tubers between February 2013 and November 2015. RESULTS Seven patients with cortical tubers were treated (4 female and 3 male). The patients' average age was 6.6 years (range 2-17 years). Two patients had a single procedure, and 5 patients had staged procedures. The mean time between procedures in the staged cases was 6 months. All of the patients had a meaningful reduction in seizure frequency as reported by Engel and ILAE seizure outcome classifications, and most (71.4%) of the patients experienced a reduction in AED burden. Three of the 4 patients who presented with neuropsychiatric symptoms had some improvement in these domains after laser ablation. No perioperative complications were noted. The mean duration of follow-up was 19.3 months (range 4-49 months). CONCLUSIONS Laser ablation represents a minimally invasive alternative to resective epilepsy surgery and is an effective treatment for refractory epilepsy due to cortical tubers.

Keywords: AED = antiepileptic drug; EEG = electroencephalography; FLAIR = fluid-attenuated inversion recovery; ILAE = International League Against Epilepsy; LITT = laser interstitial thermal therapy; MRgLITT; MRgLITT = MR-guided LITT; PET = positron emission tomography; SEGA = subependymal giant cell astrocytoma; SPECT = single photon emission computed tomography; TSC = tuberous sclerosis complex; VEEG = video-EEG; epilepsy; laser; minimally invasive surgery; pediatric; tuberous sclerosis complex.