Skip to main content

Stereotactic laser ablation for completion corpus callosotomy.

Publication ,  Journal Article
Huang, Y; Yecies, D; Bruckert, L; Parker, JJ; Ho, AL; Kim, LH; Fornoff, L; Wintermark, M; Porter, B; Yeom, KW; Halpern, CH; Grant, GA
Published in: J Neurosurg Pediatr
October 1, 2019

OBJECTIVE: Completion corpus callosotomy can offer further remission from disabling seizures when a prior partial corpus callosotomy has failed and residual callosal tissue is identified on imaging. Traditional microsurgical approaches to section residual fibers carry risks associated with multiple craniotomies and the proximity to the medially oriented motor cortices. Laser interstitial thermal therapy (LITT) represents a minimally invasive approach for the ablation of residual fibers following a prior partial corpus callosotomy. Here, the authors report clinical outcomes of 6 patients undergoing LITT for completion corpus callosotomy and characterize the radiological effects of ablation. METHODS: A retrospective clinical review was performed on a series of 6 patients who underwent LITT completion corpus callosotomy for medically intractable epilepsy at Stanford University Medical Center and Lucile Packard Children's Hospital at Stanford between January 2015 and January 2018. Detailed structural and diffusion-weighted MR images were obtained prior to and at multiple time points after LITT. In 4 patients who underwent diffusion tensor imaging (DTI), streamline tractography was used to reconstruct and evaluate tract projections crossing the anterior (genu and rostrum) and posterior (splenium) parts of the corpus callosum. Multiple diffusion parameters were evaluated at baseline and at each follow-up. RESULTS: Three pediatric (age 8-18 years) and 3 adult patients (age 30-40 years) who underwent completion corpus callosotomy by LITT were identified. Mean length of follow-up postoperatively was 21.2 (range 12-34) months. Two patients had residual splenium, rostrum, and genu of the corpus callosum, while 4 patients had residual splenium only. Postoperative complications included asymptomatic extension of ablation into the left thalamus and transient disconnection syndrome. Ablation of the targeted area was confirmed on immediate postoperative diffusion-weighted MRI in all patients. Engel class I-II outcomes were achieved in 3 adult patients, whereas all 3 pediatric patients had Engel class III-IV outcomes. Tractography in 2 adult and 2 pediatric patients revealed time-dependent reduction of fractional anisotropy after LITT. CONCLUSIONS: LITT is a safe, minimally invasive approach for completion corpus callosotomy. Engel outcomes for completion corpus callosotomy by LITT were similar to reported outcomes of open completion callosotomy, with seizure reduction primarily observed in adult patients. Serial DTI can be used to assess the presence of tract projections over time but does not classify treatment responders or nonresponders.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

J Neurosurg Pediatr

DOI

EISSN

1933-0715

Publication Date

October 1, 2019

Volume

24

Issue

4

Start / End Page

433 / 441

Location

United States

Related Subject Headings

  • Neurology & Neurosurgery
  • 3213 Paediatrics
  • 3209 Neurosciences
  • 1114 Paediatrics and Reproductive Medicine
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Huang, Y., Yecies, D., Bruckert, L., Parker, J. J., Ho, A. L., Kim, L. H., … Grant, G. A. (2019). Stereotactic laser ablation for completion corpus callosotomy. J Neurosurg Pediatr, 24(4), 433–441. https://doi.org/10.3171/2019.5.PEDS19117
Huang, Yuhao, Derek Yecies, Lisa Bruckert, Jonathon J. Parker, Allen L. Ho, Lily H. Kim, Linden Fornoff, et al. “Stereotactic laser ablation for completion corpus callosotomy.J Neurosurg Pediatr 24, no. 4 (October 1, 2019): 433–41. https://doi.org/10.3171/2019.5.PEDS19117.
Huang Y, Yecies D, Bruckert L, Parker JJ, Ho AL, Kim LH, et al. Stereotactic laser ablation for completion corpus callosotomy. J Neurosurg Pediatr. 2019 Oct 1;24(4):433–41.
Huang, Yuhao, et al. “Stereotactic laser ablation for completion corpus callosotomy.J Neurosurg Pediatr, vol. 24, no. 4, Oct. 2019, pp. 433–41. Pubmed, doi:10.3171/2019.5.PEDS19117.
Huang Y, Yecies D, Bruckert L, Parker JJ, Ho AL, Kim LH, Fornoff L, Wintermark M, Porter B, Yeom KW, Halpern CH, Grant GA. Stereotactic laser ablation for completion corpus callosotomy. J Neurosurg Pediatr. 2019 Oct 1;24(4):433–441.

Published In

J Neurosurg Pediatr

DOI

EISSN

1933-0715

Publication Date

October 1, 2019

Volume

24

Issue

4

Start / End Page

433 / 441

Location

United States

Related Subject Headings

  • Neurology & Neurosurgery
  • 3213 Paediatrics
  • 3209 Neurosciences
  • 1114 Paediatrics and Reproductive Medicine