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Adopting MR-guided stereotactic laser ablations for epileptic lesions: initial clinical experience and lessons learned

  • Original Article - Functional Neurosurgery - Epilepsy
  • Published:
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Abstract

Objective

MR-guided laser interstitial thermal therapy (MRgLITT) is a minimally invasive technique for ablating brain lesions under real-time MRI feedback and control of the ablation process. The Medtronic Visualase system was recently approved for use in Europe and Israel. We report our initial technical experience using the system in the first 16 cases in which the system was used to ablate focal epileptogenic lesions.

Methods

We included all consecutive patients with intractable epilepsy who underwent MRgLITT procedures between 2018 and 2020. We reviewed medical charts and imaging studies of patients. Post-ablation MRIs were used to calculate ablation volumes.

Results

Seventeen MRgLITT procedures were performed in 16 patients. One cooling catheter/laser fiber assemblies were placed per patient. Indications for surgery were intractable epilepsy due to TLE (n = 7), suspected low-grade glioma (n = 4), radiological cortical dysplasia (n = 1), hypothalamic hamartoma (n = 1), and MR-negative foci (n = 3). Ablations were made using 30 to 70% of the maximal energy of the Visualase system. We used serial ablations as needed along the tract of the catheter by pulling back the optic fiber; the length of the lesion ranged between 7.4 and 38.1 mm. Ablation volume ranged between 0.27 and 6.78 mm3. Immediate post-ablation MRI demonstrated good ablation of the epileptic lesion in 16/17 cases. In one case with mesial temporal sclerosis, no ablation was performed due to suboptimal position of the catheter. That patient was successfully reoperated at a later date. Mean follow-up was 14.9 months (± 11.6 months). Eleven patients had follow-up longer than 12 months. Good seizure control (Engel I, A) was achieved in 7/11 patients (63%) and 1/11 (9%) had significant improvement in seizure frequency (Angle IIIa). Three patients (27%) did not experience improvement in their seizure frequency (Engel IV, B), and one of these patients died during the follow-up period from sudden unexpected death of epilepsy (SUDEP). No immediate or delayed neurological complications were documented in any of the cases during the follow-up period.

Conclusions

MRgLITT is a promising technique and can be used safely as an alternative to open resection in both lesional and non-lesional intractable epilepsy cases. In our local series, the success rate of epilepsy surgery was comparable to recent publications.

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Authors and Affiliations

  1. Functional Neurosurgery Unit, Department of Neurosurgery, Tel-Aviv Medical Center, Tel-Aviv, Israel

    Ben Shofty, Lotem Bergman, Assaf Berger, Shani Ben-Valid, Dina Gurovich, Ariel Tankus, Miryam Attias & Ido Strauss

  2. Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel

    Orna Aizenstein, Ariel Tankus, Firas Fahoum & Ido Strauss

  3. Neuroradiology Unit, Department of Radiology, Tel-Aviv Medical Center, Tel-Aviv, Israel

    Lotem Bergman & Orna Aizenstein

  4. Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel

    Ariel Tankus

  5. Epilepsy Unit, Department of Neurology, Tel-Aviv Medical Center, Tel-Aviv, Israel

    Firas Fahoum

Authors
  1. Ben Shofty
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  2. Lotem Bergman
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  3. Assaf Berger
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  6. Dina Gurovich
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  7. Ariel Tankus
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  9. Firas Fahoum
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  10. Ido Strauss
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by BS, LB, AB, SBV, DG, MA, and FF. The first draft of the manuscript was written by BS and IS, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Ido Strauss.

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The authors declare no competing interests.

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This article is part of the Topical Collection on Functional Neurosurgery - Epilepsy

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Shofty, B., Bergman, L., Berger, A. et al. Adopting MR-guided stereotactic laser ablations for epileptic lesions: initial clinical experience and lessons learned. Acta Neurochir 163, 2797–2803 (2021). https://doi.org/10.1007/s00701-021-04903-2

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  • DOI: https://doi.org/10.1007/s00701-021-04903-2

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