Stereotactic Laser Interstitial Thermal Therapy Callosotomy for the Treatment of Atonic Seizures in Pediatric Drug-Resistant Epilepsy
Abstract number :
1.326
Submission category :
9. Surgery / 9B. Pediatrics
Year :
2021
Submission ID :
1826435
Source :
www.aesnet.org
Presentation date :
12/4/2021 12:00:00 PM
Published date :
Nov 22, 2021, 06:54 AM
Authors :
Arka Mallela, MD - University of Pittsburgh Medical Center; Jasmine Hect - School of Medicine - University of Pittsburgh Medical Center; Hussam Abou-Al-Shaar - University of Pittsburgh Medical Center; Emefa Akwayena - Department of Neurosurgery - Children's Hospital of Pittsburgh; Taylor Abel - Department of Neurosurgery - Children's Hospital of Pittsburgh
Rationale: Corpus callosotomy is an effective procedure in reducing the frequency of atonic seizures and improving quality of life in patients with drug-resistant epilepsy. Traditionally, craniotomy is performed via an open craniotomy with the morbidity associated with craniotomy. Laser interstitial thermal therapy (LITT) is a more recent that is now being applied for minimally invasive callosotomies. We aimed to investigate whether LITT could be used to successfully perform safe and effective corpus callosotomy in pediatric patients.
Methods: We present a series of 8 pediatric patients (7-21 years, M=14.4, SD=5.1 years), who have undergone MRI-guided LITT callosotomy at our institution for the treatment of drug-refractory primary generalized epilepsy with atonic seizures. Three underwent complete callosotomy, 2 underwent anterior 2/3 callosotomy, and 2 underwent LITT as completion posterior callosotomy after prior open procedure.
Results: All cases were performed without intraoperative complication. A total of 3-4 trajectories were used for complete and anterior 2/3 callosotomy while 1-2 trajectories were utilized for the posterior one-third completion callosotomy. Surgery length ranged from 4-8 hours (M=5.8, SD=1.7). Patients were discharged after a median of 3 days (range 1-6). One patient continues to have symptoms of disconnection syndrome at six months. 66.7% of patients with frequent pre-operative atonic seizures and adequate follow-up (N=6) were free from atonic seizures at most recent follow-up, while 83% of patients experienced a worthwhile improvement in overall seizure frequency by 3-month follow-up. Based on our series, we also identify an imaging pattern of DWI/FLAIR/T1 changes characteristic of successful laser ablation.
Conclusions: In our series, LITT callosotomy is safe for the treatment of drug-resistant epilepsy in children and may offer lower invasiveness and morbidity than open callosotomy. Further, shorter hospital length of stay of LITT callosotomy may have implications for the overall cost-effectiveness of callosotomy relative to other palliative epilepsy surgery modalities.
Funding: Please list any funding that was received in support of this abstract.: None.
Surgery