Abstracts

Rationale: Over 3 million Americans suffer from epilepsy, with about 30% having intractable disease. Laser ablation is rapidly becoming a more important tool in epilepsy surgery. Previously laser ablation has been for amygdalo-hippocampotomies¹, as well as lesionectomies and disconnection procedures. We report the use of laser ablation for two cases of corpus callosotomy. Our hypothesis is that this procedure by laser is as effective as open surgery, which is the traditional approach and remains the gold standard at this time. In addition, the laser approach results in decreased need for pain medication and shorter length of hospitalization. Methods: Patients were evaluated for surgery candidacy with standard protocol including MRI, long term video EEG monitoring, PET, neuropsychological testing, and discussion in the epilepsy surgical conference. A MR-compatible stereotactic head frame was used in conjunction with stereotactic planning software for accurate placement of laser catheter, with one located in to the rostrum of the corpus callosum (CC) and the second in the body of the CC. The Visualase system was used with real time magnetic resonance thermal imaging in order to perform laser ablation of multiple lesions. Once completed, lasers were removed, and a single stitch was used to close surgical wound. Results: The first patient was an 11 year old male with intractable epilepsy with both generalized and focal onset with cortical heterotopia, which was bilateral and not felt to be resectable. His procedure had no complications, and patient was moved to floor bed on post-op day 1 and discharged post-op day 2. After surgery, drop attacks have resolved, speech and cognition have improved, and he has had only 8 seizures in 4 months as compared to a pre-surgery frequency varying from daily with clusters of 8-10 seizures up to 1 seizure every 2 weeks. The second patient was a 23 year old female with intractable epilepsy status post VNS placement and incomplete disconnection with a prior hemispherectomy. Her corpus callosotomy by laser ablation was performed without complication. Patient was monitored overnight and discharged on post op day 1 on regular diet and PO pain pills. Follow up after 3 months revealed resolution of drop attacks and daytime seizures and reduction of night time seizures from 3-4 seizures per night to 1 per night with rare weekly cluster of 3 nighttime seizures. Conclusions: Recent results for two corpus callosotomies by laser ablation show promising results and that this technique has initial evidence for similar efficacy as traditional open surgery with the benefit of decreased pain, need for pain meds, and hospital length of stay.