Magnetic Resonance-guided Laser Interstitial Thermal Therapy Is a Promising Alternative for Open Surgery in the Management of Bottom-of-sulcus Dysplasia Related Epilepsy: A Comparative Study
Abstract number :
1.446
Submission category :
9. Surgery / 9A. Adult
Year :
2024
Submission ID :
856
Source :
www.aesnet.org
Presentation date :
12/7/2024 12:00:00 AM
Published date :
Authors :
Presenting Author: Bowen Yang, MD, PhD – Beijing Tiantan Hospital
Weiyuan Luo, MD – Beijing Tiantan Hospital
Chao Zhang, MD – Beijing Tiantan Hospital
Xiu Wang, MD, PhD – Beijing Tiantan Hospital
Kai Zhang, MD – Beijing Tiantan Hospital
Wenhan Hu, MD – Beijing Tiantan Hospital
Rationale: This study assessed the efficacy and safety of magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) versus open surgery (OS) for the treatment of patients with epilepsy and bottom-of-sulcus dysplasia (BOSD).
Methods: Twenty-two patients underwent MRgLITT, and 39 underwent OS. Postoperative seizure-free rates were analyzed using Kaplan-Meier curves. The removal ratio, which represents the extent of damage, was calculated based on preoperative lesion volume and postoperative removal volume. Other outcomes including adverse events, operative time, and hospital stay were also compared. Subgroup analyses of insulo-opercular involvement, Rolandic involvement, and history of epilepsy surgery were performed.
Results: The Kaplan-Meier curves indicated the seizure-free rates were comparable between MRgLITT (90.9%, 26.5 [23.0, 35.1] months) and OS (89.7%, 25.2 [16.2, 34.6] months) groups (p = 0.901, log-rank test) at the final follow-up. The removal ratio of MRgLITT (1.3 [1.1, 1.7]) was significantly lower (p=0.007) than that of OS (5.8 [3.6, 8.5]). A comparison of postoperative neurological deficits, infection rates, and fever rates revealed no significant differences between MRgLITT and OS groups. The operative time (hours) of MRgLITT (3.0, [2.1, 4.9]) was significantly shorter (p=0.007) than that of OS (3.5 [3.0, 4.5]). The hospital stay (days) after MRgLITT (6 [5.0, 7.5]) was significantly shorter (p< 0.001) than that of OS (11.0 [9.0, 13.5]). MRgLITT demonstrated superiority over open surgery in cases involving insulo-opercular regions, with MRgLITT’s comparable effectiveness observed in both insulo-opercular and other regions (p = 0.338), contrasting with open surgery's lower seizure-free rates in insulo-opercular cases compared to other regions (p = 0.022).
Conclusions: MRgLITT has advantages over OS, including reduced removal ratios, shorter operative time, shorter hospital stays, and improved surgical outcomes in cases with insulo-opercular involvement, achieving comparable seizure control and adverse event profiles.
Funding: None
Surgery