Authors :
Presenting Author: CHAITHANYA REDDY BANDI V, MD – cincinnati children hospital and medical center
Ravindra Arya, MD – Cincinnati Children's Hospital Medical Center; Hansel Greiner, MD – Cincinnati Children's Hospital Medical Center; Katie Holland-Bouley, MD – Cincinnati Children's Hospital Medical Center; james Leach, MD – Cincinnati Children's Hospital Medical Center; francesco Mangano, MD – Cincinnati Children's Hospital Medical Center; Jesse Skoch, MD – Cincinnati Children's Hospital Medical Center
Rationale:
The efficacy of Magnetic resonance imaging (MRI)-guided laser interstitial thermal therapy (MRg-LITT) for MRI-negative nonlesional epilepsy is sparsely reported outside of the temporal lobe. Although a few case series reported varying seizure freedom rates (33% to 67%) with at least one to two years of follow-up, they did not highlight the details by the anatomic area of seizure onset.
1 Cingulate epilepsy is challenging surgically due to its deep location but is amenable to LITT given the tubular gyral orientation. This study aims to evaluate the success rate of MRg-LITT in treating nonlesional cingulate epilepsy in the pediatric population.
Methods:
We retrospectively reviewed sequential cases of patients who underwent cingulate MRg-LITT for refractory nonlesional epilepsy between 2016 and 2020 using a standard multimodal approach. Standard stereotactic techniques, MRI thermometry, and a commercial laser thermal therapy system were used for ablations
Results:
Five patients (three females and two males) with a mean epilepsy duration of 4.1 (1.9 to 8.5) years underwent MRg-LITT at a mean age of 9.1 (3.4 to 18.9) years for refractory cingulate epilepsy. The mean follow-up was 4.8 (3.3 to 5.8) years. Prior history of epilepsy surgeries was noted in one patient. Three patients had isolated cingulate (two posteriors and one anterior) seizure onsets on stereo-encephalography (SEEG), and one had simultaneous seizure onsets in the temporal and anterior cingulate areas. Seizures were not captured for one patient. The surgical plan was based on the interictal discharges seen in the parietal and posterior cingulate areas. Following MRg-LITT, two patients with isolated cingulate origins were seizure-free (International League Against Epilepsy [ILAE] class I) at follow-up. One of them experienced partial seizure control (ILAE class IV) after initial MRg-LITT and later underwent additional surgical procedures (left insular ablation) before achieving seizure freedom. All other patients responded favorably to treatment (ILAE class III-IV) and tried afterward other surgical interventions, including stereotactic resections, additional laser ablations, and VNS. One patient had transient right-side numbness and tingling sensations post-operatively.
Conclusions:
This study has the most extended follow-up data on patients who received cingulate MRg-LITT for refractory nonlesional epilepsy, particularly in the pediatric population. This procedure was well tolerated and yielded good outcomes in all the patients. The seizure freedom rate was 40% in this cohort. It has reached up to 67% in patients with an isolated cingulate focus on SEEG. MRg-LITT is a promising, minimally invasive approach for the treatment of cingulate epilepsies.
1Van Gompel JJ et al. Laser Interstitial Thermal Therapy for Epilepsy. Neurosurg Clin N Am. 2023.
Funding: None