Abstracts

CORPUS CALLOSOTOMY WITH STEREOTACTIC LASER ABLATION IN A PEDIATRIC PATIENT

Abstract number : 2.347
Submission category : 9. Surgery
Year : 2014
Submission ID : 1868429
Source : www.aesnet.org
Presentation date : 12/6/2014 12:00:00 AM
Published date : Sep 29, 2014, 05:33 AM

Authors :
Alison Dolce, Daniel Curry and Angus Wilfong

Rationale: Corpus callosotomy is a valuable palliative surgical treatment option for patients with medically intractable epilepsy and has been shown to be especially effective in those patients with drop attacks (atonic or tonic) and seizures that rapidly secondarily generalize. There are numerous potential surgical and neurological complications associated with conventional open surgical callosotomy as well as concerns regarding radiation overexposure in pediatic patients with the less invasive radiosurgical callosotomy. An alternative minimally invasive treatment option, with reduced side effects, is essential; therefore, we performed an anterior two-thirds callosotomy with stereotactic laser ablation (SLA). Methods: We describe a ten year old girl with medically intractable localization-related epilepsy with multifocal onset secondarily generalized seizures, associated with extensive bilateral polymicrogyria. Despite management with multiple antiepileptic medications, the ketogenic diet, and vagus nerve stimulation, this patient continued to have disabling atonic drop seizures. Given the refractory nature of her seizures, an anterior two-thirds corpus callosotomy was completed via minimally invasive MR-guided stereotactic laser ablation (SLA), with a primary goal to reduce the number of atonic seizures. The procedure was performed using a recently FDA approved laser surgery system (Visualase, Inc.). Results: The patient demonstrated significant clinical improvement after SLA of the corpus callosum and was free of atonic seizures for four months after surgery. She then experienced a recurrence of atonic seizures, but at a significantly decreased frequency as well as a decreased number of daytime atypical absence and myoclonic seizures. She also developed an increase in nocturnal tonic seizures following the procedure. The patient experienced a transient decrease in speech, alien hand syndrome and difficulty with ambulation that completely resolved by four months. She also experienced decreased strength in her left arm and leg that has continued to improve with therapy. As the patient tolerated the procedure extremely well with no injury to surrounding tissue or vascular structures, we suspect that her longer than expected recovery was likely a consequence of our inability to use steroids in the pre and postoperative period due to her being on the ketogenic diet. Additional benefit as reported by the family was a significant improvement in speech, cognition and overall quality of life. Conclusions: The concept of treatment of epileptogenic foci in children using laser ablation has been recently reported and considered a safe and effective therapeutic option. To our knowledge, there is no description of its use as a minimally invasive neurosurgical technique to perform a corpus callosotomy. Our result suggests that corpus callosotomy using SLA, a novel therapeutic approach, may be a safe and effective alternative to conventional open surgical and radiosurgical callosotomy in these carefully selected cases of medically intractable epilepsy.
Surgery