Laser Ablation of the Corpus Callosum in the Treatment of Refractory Pediatric Epilepsy
Abstract number :
3.454
Submission category :
9. Surgery / 9B. Pediatrics
Year :
2024
Submission ID :
410
Source :
www.aesnet.org
Presentation date :
12/9/2024 12:00:00 AM
Published date :
Authors :
Presenting Author: Kevin Chapman, MD – Phoenix Children's Hospital
Randa Jarrar, MD – Phoenix Children’s Hospital
Korwyn Williams, MD – Phoenix Children's Hospital
John Kerrigan, MD – Phoenix Children's Hospital
Jordana Fox Kensicki, DO – Phoenix Children's Hospital
Gary Morris, MD – Phoenix Children's Hospital
Brian Appavu, MD – Phoenix Children's Hospital
Angus Wilfong, MD – Phoenix Children's Hospital
Rationale: Corpus callosotomy has been a palliative surgical treatment of drug resistant epilepsy since the 1940s and is most commonly used to treat drop seizures associated with Lennox-Gastaut syndrome (LGS). MRI-guided laser interstitial thermal therapy uses a small fiberoptic catheter that is placed stereotactically to thermally ablate a small volume of brain tissue. We describe the outcome of using this technique for corpus callosotomy at a single large academic tertiary epilepsy center.
Methods: This is a retrospective chart review of patients who underwent laser interstitial thermal ablation of the corpus callosum (LITT CC) at Phoenix Children’s Hospital between January 2010 to December 2023. Patient were included if they had at least three months of postoperative follow-up.
Results: A total of 16 patients met inclusion criteria with 3 having repeat LITT CC procedures performed for incomplete treatment response. The cohort had refractory epilepsy with patients previously attempting a mean of 8 antiseizure medications. 31% had failed dietary therapy and 75% had received vagus nerve stimulation or implantation. The procedures were well tolerated with all patients discharged the day following surgery. Three patients were readmitted within the first 30 days due to altered mental status (2) and urinary tract infection (1). A worthwhile improvement ( >50% reduction in seizures) was seen in 81% with a mean follow-up of 12 months (range 7-20). 80% of patients with drop seizures were seizure free of drops seizures at last follow-up. Two patients were seizure free for all seizure types.
Conclusions: LITT CC was shown to be particularly effective in the treatment of drop seizures in this highly refractory cohort. Other seizure types had variable reduction in frequency, but most patients had a worthwhile improvement in seizure control. The procedure was well tolerated with all patients discharged the following day. Our results suggest that LITT CC should be considered in refractory drop seizures in patients with a corpus collosum present. Further studies should evaluate predictive markers of treatment response for patients in a larger cohort.
Funding: None
Surgery