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Prolonged Blood-Brain Barrier Disruption Following Laser Interstitial Ablation in Epilepsy: A Case Series with a Case Report of Postablation Optic Neuritis.

Publication ,  Journal Article
Morris, S-A; Rollo, M; Rollo, P; Johnson, J; Grant, GA; Friedman, E; Kalamangalam, G; Tandon, N
Published in: World Neurosurg
August 2017

OBJECTIVE: Laser interstitial thermal therapy has become increasingly popular for targeting epileptic foci in a minimally invasive fashion. Despite its use in >1000 patients, the long-term effects of photothermal injury on brain physiology remain poorly understood. METHODS: We prospectively followed clinical and radiographic courses of 13 patients undergoing laser ablation for focal epilepsy by the senior author (N.T.). Only patients with nonenhancing lesions and patients who had a delayed postoperative magnetic resonance imaging (MRI) scan with gadolinium administration approximately 6 months after ablation were considered. Volumetric estimates of the amount of enhancement immediately after ablation and on the delayed MRI scan were made. RESULTS: Median interval between surgery and delayed postoperative MRI scan was 6 months (range, 5-8 months). In 12 of 13 cases, persistent enhancement was seen, consistent with prolonged blood-brain barrier dysfunction. Enhancement, when present, was 9%-67% (mean 30%). There was no correlation between the time from surgery and the relative percentage of postoperative enhancement on MRI. The blood-brain barrier remained compromised to gadolinium contrast for up to 8 months after thermal therapy. There were no adverse events from surgical intervention; however, 1 patient developed delayed optic neuritis. CONCLUSIONS: Prolonged incompetence of the blood-brain barrier produced by thermal ablation may provide a path for delivery of macromolecules into perilesional tissue, which could be exploited for therapeutic benefit, but rarely it may result in autoimmune central nervous system inflammatory conditions.

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Published In

World Neurosurg

DOI

EISSN

1878-8769

Publication Date

August 2017

Volume

104

Start / End Page

467 / 475

Location

United States

Related Subject Headings

  • Young Adult
  • Surgery, Computer-Assisted
  • Stereotaxic Techniques
  • Prospective Studies
  • Postoperative Complications
  • Optic Neuritis
  • Middle Aged
  • Male
  • Magnetic Resonance Imaging
  • Laser Therapy
 

Citation

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Morris, S.-A., Rollo, M., Rollo, P., Johnson, J., Grant, G. A., Friedman, E., … Tandon, N. (2017). Prolonged Blood-Brain Barrier Disruption Following Laser Interstitial Ablation in Epilepsy: A Case Series with a Case Report of Postablation Optic Neuritis. World Neurosurg, 104, 467–475. https://doi.org/10.1016/j.wneu.2017.05.009
Morris, Saint-Aaron, Matthew Rollo, Patrick Rollo, Jessica Johnson, Gerald A. Grant, Elliott Friedman, Giridhar Kalamangalam, and Nitin Tandon. “Prolonged Blood-Brain Barrier Disruption Following Laser Interstitial Ablation in Epilepsy: A Case Series with a Case Report of Postablation Optic Neuritis.World Neurosurg 104 (August 2017): 467–75. https://doi.org/10.1016/j.wneu.2017.05.009.
Morris S-A, Rollo M, Rollo P, Johnson J, Grant GA, Friedman E, et al. Prolonged Blood-Brain Barrier Disruption Following Laser Interstitial Ablation in Epilepsy: A Case Series with a Case Report of Postablation Optic Neuritis. World Neurosurg. 2017 Aug;104:467–75.
Morris, Saint-Aaron, et al. “Prolonged Blood-Brain Barrier Disruption Following Laser Interstitial Ablation in Epilepsy: A Case Series with a Case Report of Postablation Optic Neuritis.World Neurosurg, vol. 104, Aug. 2017, pp. 467–75. Pubmed, doi:10.1016/j.wneu.2017.05.009.
Morris S-A, Rollo M, Rollo P, Johnson J, Grant GA, Friedman E, Kalamangalam G, Tandon N. Prolonged Blood-Brain Barrier Disruption Following Laser Interstitial Ablation in Epilepsy: A Case Series with a Case Report of Postablation Optic Neuritis. World Neurosurg. 2017 Aug;104:467–475.
Journal cover image

Published In

World Neurosurg

DOI

EISSN

1878-8769

Publication Date

August 2017

Volume

104

Start / End Page

467 / 475

Location

United States

Related Subject Headings

  • Young Adult
  • Surgery, Computer-Assisted
  • Stereotaxic Techniques
  • Prospective Studies
  • Postoperative Complications
  • Optic Neuritis
  • Middle Aged
  • Male
  • Magnetic Resonance Imaging
  • Laser Therapy