Magnetic resonance-guided laser interstitial thermal therapy for the treatment of non-lesional insular epilepsy in pediatric patients: thermal dynamic and volumetric factors influencing seizure outcomes.

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Citation: Childs Nervous System. 35(3):453-461, 2019 03.PMID: 30627771Institution: MedStar Washington Hospital CenterDepartment: NeurosurgeryForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Epilepsy/su [Surgery] | *Intraoperative Neurophysiological Monitoring/mt [Methods] | *Laser Therapy/mt [Methods] | *Surgery, Computer-Assisted/mt [Methods] | Adolescent | Cerebral Cortex/su [Surgery] | Child | Electroencephalography/mt [Methods] | Female | Humans | Magnetic Resonance Imaging/mt [Methods] | Male | Retrospective StudiesYear: 2019ISSN:
  • 0256-7040
Name of journal: Child's nervous system : ChNS : official journal of the International Society for Pediatric NeurosurgeryAbstract: CONCLUSIONS: The proportion of insula ablated, as well as the volume of ablation, are related to seizure outcome with increasing ablation volumes corresponding to improved seizure control. Further analysis of insula laser ablation thermal dynamics and volumes is needed.METHODS: A single-institution, retrospective review of pediatric patients with insular epilepsy who underwent sEEG directed MRgLITT over a 10-month period was performed. Perioperative, imaging, and outcome data were analyzed. Seizure outcomes were determined based on Engel score (Engel I versus Engel II-IV). Insula and ablation volumes were measured, and the proportion of insula volume ablated was calculated. Thermal energy was calculated in joules.PURPOSE: To investigate the safety and efficacy of stereoelectroencephalography (sEEG) directed magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) in medically refractory insular epilepsy in pediatric patients, define the relationship between ablation volumes and seizure control, and analyze the relationship between thermal energy and ablation volumes.RESULTS: Four patients underwent sEEG directed MRgLITT of insular epileptogenic foci. The ablation volume was higher in patients with Engel I outcome (3.93 cm<sup>3</sup>) compared to Engel II-IV outcome (1.02 cm<sup>3</sup>). The proportion of ablation to insula volume was lowest in patients with Engel II-IV outcome (25.09%). The mean energy requirement to create a unit volume of ablation in the insula is 1205.86 J. A linear trend was noted between thermal ablation energy and ablation volume (R<sup>2</sup> = 0.884). Over a mean follow-up period of 104 days, three patients were seizure-free (Engel I), and one patient saw significant improvement in seizure frequency (Engel III).All authors: Alexander H, Cobourn K, Depositario-Cabacar D, Fayed I, Gaillard WD, Keating RF, Oluigbo COOriginally published: Childs Nervous System. 2019 Jan 09Fiscal year: FY2019Digital Object Identifier: ORCID: Date added to catalog: 2019-01-18
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Journal Article MedStar Authors Catalog Article 30627771 Available 30627771

CONCLUSIONS: The proportion of insula ablated, as well as the volume of ablation, are related to seizure outcome with increasing ablation volumes corresponding to improved seizure control. Further analysis of insula laser ablation thermal dynamics and volumes is needed.

METHODS: A single-institution, retrospective review of pediatric patients with insular epilepsy who underwent sEEG directed MRgLITT over a 10-month period was performed. Perioperative, imaging, and outcome data were analyzed. Seizure outcomes were determined based on Engel score (Engel I versus Engel II-IV). Insula and ablation volumes were measured, and the proportion of insula volume ablated was calculated. Thermal energy was calculated in joules.

PURPOSE: To investigate the safety and efficacy of stereoelectroencephalography (sEEG) directed magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) in medically refractory insular epilepsy in pediatric patients, define the relationship between ablation volumes and seizure control, and analyze the relationship between thermal energy and ablation volumes.

RESULTS: Four patients underwent sEEG directed MRgLITT of insular epileptogenic foci. The ablation volume was higher in patients with Engel I outcome (3.93 cm<sup>3</sup>) compared to Engel II-IV outcome (1.02 cm<sup>3</sup>). The proportion of ablation to insula volume was lowest in patients with Engel II-IV outcome (25.09%). The mean energy requirement to create a unit volume of ablation in the insula is 1205.86 J. A linear trend was noted between thermal ablation energy and ablation volume (R<sup>2</sup> = 0.884). Over a mean follow-up period of 104 days, three patients were seizure-free (Engel I), and one patient saw significant improvement in seizure frequency (Engel III).

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