Authors :
Presenting Author: Daniel Biro, MD, PhD – Univeristy of Chicago
Johanna Rau, Dr. Med – University of Chicago
Audrey Oetemo, MSN – University of Chicago
Douglas Nordli, MD – University of Chicago
Peter Warnke, MD, Dr. Med – University of Chicago
Rationale:
Focal cortical dysplasia is a challenging disease that arises from a disorder of cortical development and structuring, and is a leading cause of refractory epilepsy. Patients with FCD, particularly in the pediatric population who commonly have the more severe form of the disease, are often refractory to medical treatment and require surgical evaluation and treatment. Traditionally this has consisted of imaging studies and stereo electroencephalography (sEEG), followed by craniotomy for surgical resection of the dysplastic area and epileptogenic focus. However, due to difficulties in fully elucidating the area of dyplasia, surgical cure rates also remain stubbornly low while maintaining the high risks associated with open craniotomy. According to reviews of the literature, approximately 60-80% remain seizure free after surgery with open techniques. Approximately 30% of patients have subtotal resection, traditionally attributed to the difficulty of identifying the area on imaging. New surgical techniques such as Laser Interstitial Thermal Therapy could be used to achieve ablation of epileptic dysplastic tissue while reducing the risks and costs of performing open craniotomy. These techniques have been demonstrated to be safe and effective in seizure disorders associated with mesial temporal lobe epilepsy, cavernoma, and other disease.
Methods:
In order to evaluate whether the risks of open craniotomy could be mitigated while achieving comparable rates of seizure reduction to open techniques, we evaluated a series of 6 patients who underwent surgery for FCD between January 2019 and May 2023. Patients who had undergone prior resective or ablative surgery were excluded. Patients who had an identified area of FCD on imaging, and seizures poorly controlled with medication were included. All patients underwent LITT of the area of identified FCD. One patient underwent ECoG guidance and 5 underwent pre ablative evaluation with sEEG. Average age at time of surgery was 13.8 years.
Results:
All patients were discharged home from ICU care on post op day 1. Follow up ranged from 11 months to 5 years. 4 patients achieved a long term reduction in seizures freedom as defined by Engels outcome scale class 1 (67%). One patient achieved near seizure freedom as defined by Engels class 2 (16%) and one patient achieved worthwhile improvement as defined by Engels class 3. No post operative complications were reported. One patient required re-operation with open craniotomy for persistent seizures. FCD subtype was confirmed by biopsy for one patient as FCD type 2B, who achieved an Engels class of 1A.
Conclusions:
LITT has the potential to be a safe and effective alternative to open craniotomy for treatment of seizures arising from FCD. Rates of seizure reduction in our study are comparable to that reported in the literature. There were no post operative complications, although there was one patient who required repeat surgery, this is again in line with what is seen for open surgery. Of note, all six patients were discharged home on post op day 1, which implies that LITT likely provides an improved cost and safety profile over traditional techniques while achieving similar efficacy.
Funding: No funding source