Stereoelectroencephalography Followed by MR-Guided Laser Interstitial Thermal Therapy or Open Resection for Treatment of Pediatric Medically-Refractory Epilepsy: A Single-Center Experience of 60 Cases
Abstract number :
1.325
Submission category :
9. Surgery / 9B. Pediatrics
Year :
2021
Submission ID :
1826552
Source :
www.aesnet.org
Presentation date :
12/4/2021 12:00:00 PM
Published date :
Nov 22, 2021, 06:54 AM
Authors :
Anna Slingerland, BS - Boston Children's Hospital; Melissa Chua, MD - Resident, Neurosurgery, Boston Children's Hospital; Joseph Madsen, MD - Neurosurgeon, Neurosurgery, Boston Children's Hospital; Steven Staffa, MS - Statistician, Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital; Scellig Stone, MD, PhD, FRCSC - Neurosurgical Director, Neurosurgery, Boston Children's Hospital
Rationale: Stereoelectroencephalography (sEEG) and Magnetic Resonance-guided Laser Interstitial Thermal Therapy (MRgLITT) have emerged as safe, effective, and less invasive alternatives to subdural grid placement and open resection respectively for the localization and treatment of medically refractory epilepsy (MRE) in children. Reported pediatric experience combining these complementary techniques is limited. We describe the largest series of pediatric epilepsy patients undergoing MRgLITT following sEEG, contrasted with a cohort undergoing craniotomy following sEEG. This study aims to identify any differences in outcome between the two surgical approaches as well as to determine whether certain resection/ablation locations tended to be treated by one approach over the other.
Methods: All patients with MRE who underwent sEEG followed by MRgLITT or open resection/disconnection/hemispherectomy at Boston Children’s Hospital between November 2015 and December 2020 were retrospectively reviewed. Primary outcome variables included surgical complication rates, length of hospital stay following treatment, and Engel classification at last follow-up.
Results: Out of 60 sEEG patients, 21 (median age 12.1 years, 66.7% female) underwent MRgLITT, and 39 (median age 11.5 years, 43.6% female) underwent craniotomy for treatment of MRE. Fifty-seven patients (95%) underwent sEEG followed by combined electrode removal and treatment. Eight MRgLITT cases (33.3%), and no open cases, targeted the insula (p< 0.001). Complication rates did not significantly differ, though trends to more subdural/epidural hematomas, infarcts, and permanent unanticipated neurological deficits were evident following craniotomy, while a trend to more temporary unanticipated neurologic deficits was seen following MRgLITT. The median duration of hospitalization after treatment was 3 and 5 days for MRgLITT and open cases respectively (p< 0.001). Seizure outcomes were similar, with 57% of MRgLITT and 59% of craniotomy patients achieving seizure freedom (Engel class I) at last follow-up (p=0.878, median 14.8 and 18.2 months respectively).
Surgery