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A novel technique for frame-based MR-guided laser ablation in an infant

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Abstract

Hypothalamic hamartomata (HH) not only are usually associated with drug-resistant epilepsy but can also cause precocious puberty and developmental delay. Gelastic seizures are the most common type of seizures. Magnetic resonance image (MRI)-guided laser interstitial thermal therapy (LiTT) is a technique whereby a laser fibre is stereotactically implanted into a target lesion and heat is used to ablate whilst tissue temperature is monitored using MRI thermography. MRI-guided LiTT has proven to be an effective and safe method to treat HH. To use the LiTT system, highly accurate stereotactic fibre implantation is required. This can be achieved by the use of frame-based or frameless neuronavigation techniques. However, these techniques generally involve rigid head immobilisation using cranial pin fixation. Patients need sufficient skull thickness to safely secure the pins and sufficient skull rigidity to prevent deformation. Hence, most of the clinical reports on the use of LiTT for children describe patients aged 2 years or older. We report a novel and practical technique of using a paste cast helmet to securely place a stereotactic frame in a 5-month-old infant with HH and drug-resistant epilepsy that allowed the successful application of MRI-guided LiTT.

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Availability of data and materials

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

References

  1. Berkovic SF, Andermann F, Melanson D et al (1988) Hypothalamic hamartomas and ictal laughter: evolution of a characteristic epileptic syndrome and diagnostic value of magnetic resonance imaging. Ann Neurol 23:429–439

    Article  CAS  PubMed  Google Scholar 

  2. Kuzniecky R, Guthrie B, Mountz J et al (1997) Intrinsic epileptogenesis of hypothalamic hamartomas in gelastic epilepsy. Ann Neurol 42:60–67

    Article  CAS  PubMed  Google Scholar 

  3. CorbetBurcher G, Liang H, Lancaster R et al (2019) Neuropsychiatric profile of paediatric hypothalamic hamartoma: systematic review and case series. Dev Med Child Neurol 61:1377–1385

    Article  Google Scholar 

  4. Cascino GD, Andermann F, Berkovic SF et al (1993) Gelastic seizures and hypothalamic hamartomas: evaluation of patients undergoing chronic intracranial EEG monitoring and outcome of surgical treatment. Neurology 43:747–750

    Article  CAS  PubMed  Google Scholar 

  5. Wei P-H, An Y, Fan X-T et al (2018) Stereoelectroencephalography-guided radiofrequency thermocoagulation for hypothalamic hamartomas: preliminary evidence. World Neurosurg 114:e1073–e1078

    Article  PubMed  Google Scholar 

  6. Curry DJ, Raskin J, Ali I, Wilfong AA (2018) MR-guided laser ablation for the treatment of hypothalamic hamartomas. Epilepsy Res 142:131–134

    Article  PubMed  Google Scholar 

  7. Xu DS, Chen T, Hlubek RJ et al (2018) Magnetic resonance imaging-guided laser interstitial thermal therapy for the treatment of hypothalamic hamartomas: a retrospective review. Neurosurgery 83:1183–1192

    Article  PubMed  Google Scholar 

  8. Riordan M, Tovar-Spinoza Z (2014) Laser induced thermal therapy (LITT) for pediatric brain tumors: case-based review. Transl Pediatr 3:229–235

    PubMed  PubMed Central  Google Scholar 

  9. Hoppe C, Helmstaedter C (2020) Laser interstitial thermotherapy (LiTT) in pediatric epilepsy surgery. Seizure 77:69–75

    Article  PubMed  Google Scholar 

  10. Hartnett S, Curry DJ (2020) LITT in pediatric epilepsy. Laser Interstitial Thermal Therapy in Neurosurgery 127–149

  11. Balasundaram P, Avulakunta ID (2021) Bayley scales of infant and toddler development. In: StatPearls. StatPearls Publishing, Treasure Island (FL)

  12. Joswig H, Benson CM, Parrent AG et al (2018) Operative nuances of stereotactic Leksell frame-based depth electrode implantation. Oper Neurosurg (Hagerstown) 15:292–295

    Article  PubMed  Google Scholar 

  13. Sharma JD, Seunarine KK, Tahir MZ, Tisdall MM (2019) Accuracy of robot-assisted versus optical frameless navigated stereoelectroencephalography electrode placement in children. J Neurosurg Pediatr 23:297–302

    Article  PubMed  Google Scholar 

  14. Rekate HL, Feiz-Erfan I, Ng Y-T et al (2006) Endoscopic surgery for hypothalamic hamartomas causing medically refractory gelastic epilepsy. Childs Nerv Syst 22:874–880

    Article  PubMed  Google Scholar 

  15. Wait SD, Abla AA, Killory BD et al (2011) Surgical approaches to hypothalamic hamartomas. Neurosurg Focus 30:E2

    Article  PubMed  Google Scholar 

  16. Shim K-W, Chang J-H, Park Y-G et al (2008) Treatment modality for intractable epilepsy in hypothalamic hamartomatous lesions. Neurosurgery 62:847–56; discussion 856

  17. Kuzniecky RI, Guthrie BL (2003) Stereotactic surgical approach to hypothalamic hamartomas. Epileptic Disord 5:275–280

    PubMed  Google Scholar 

  18. Kameyama S, Murakami H, Masuda H, Sugiyama I (2009) Minimally invasive magnetic resonance imaging-guided stereotactic radiofrequency thermocoagulation for epileptogenic hypothalamic hamartomas. Neurosurgery 65:438–49; discussion 449

  19. Rosenfeld JV, Feiz-Erfan I (2007) Hypothalamic hamartoma treatment: surgical resection with the transcallosal approach. Semin Pediatr Neurol 14:88–98

    Article  PubMed  Google Scholar 

  20. Ferrand-Sorbets S, Fohlen M, Delalande O et al (2020) Seizure outcome and prognostic factors for surgical management of hypothalamic hamartomas in children. Seizure 75:28–33

    Article  PubMed  Google Scholar 

  21. Régis J, Scavarda D, Tamura M et al (2006) Epilepsy related to hypothalamic hamartomas: surgical management with special reference to gamma knife surgery. Childs Nerv Syst 22:881–895

    Article  PubMed  Google Scholar 

  22. Ng Y-T, Rekate HL, Prenger EC et al (2008) Endoscopic resection of hypothalamic hamartomas for refractory symptomatic epilepsy. Neurology 70:1543–1548

    Article  PubMed  Google Scholar 

  23. Rolston JD, Chang EF (2016) Stereotactic laser ablation for hypothalamic hamartoma. Neurosurg Clin N Am 27:59–67

    Article  PubMed  Google Scholar 

  24. Curry DJ, Gowda A, McNichols RJ, Wilfong AA (2012) MR-guided stereotactic laser ablation of epileptogenic foci in children. Epilepsy Behav 24:408–414

    Article  PubMed  Google Scholar 

  25. Krishnan P, Kumar SK, Kartikueyan R, Patel SM (2016) Pin-site epidural hematoma: a catastrophic complication of cranial fixation in a child. J Neurosci Rural Pract 7:286–289

    Article  PubMed  PubMed Central  Google Scholar 

  26. Parenrengi MA, Adhiatmadja F, Arifianto MR et al (2019) Bilateral skull fracture with massive epidural hematoma secondary to pin-type head fixation in a pediatric patient: case report and review of the literature. Int J Surg Case Rep 62:43–49

    Article  PubMed  PubMed Central  Google Scholar 

  27. Berry C, Sandberg DI, Hoh DJ et al (2008) Use of cranial fixation pins in pediatric neurosurgery. Neurosurgery 62:913–8; discussion 918–9

  28. Southwell DG, Birk HS, Larson PS et al (2018) Laser ablative therapy of sessile hypothalamic hamartomas in children using interventional MRI: report of 5 cases. J Neurosurg Pediatr 21:460–465

    Article  PubMed  Google Scholar 

  29. Aoki N, Sakai T (1989) Modified application of three-point skull clamp for infants. Neurosurgery 25:660–662

    Article  CAS  PubMed  Google Scholar 

  30. Sgouros S, Grainger MC, McCallin S (2005) Adaptation of skull clamp for use in image-guided surgery of children in the first 2 years of life. Childs Nerv Syst 21:148–149

    Article  CAS  PubMed  Google Scholar 

  31. Lee M, Rezai AR, Chou J (1994) Depressed skull fractures in children secondary to skull clamp fixation devices. Pediatr Neurosurg 21:174–7; discussion 178

  32. Hooten KG, Werner K, Mikati MA, Muh CR (2018) MRI-guided laser interstitial thermal therapy in an infant with tuberous sclerosis: technical case report. J Neurosurg Pediatr 23:92–97

    Article  PubMed  Google Scholar 

  33. Lee JJ, Clarke D, Hoverson E et al (2021) MRI-guided laser interstitial thermal therapy using the Visualase system and Navigus frameless stereotaxy in an infant: technical case report. J Neurosurg Pediatr 1–4

  34. Pruitt R, Gamble A, Black K et al (2017) Complication avoidance in laser interstitial thermal therapy: lessons learned. J Neurosurg 126:1238–1245

    Article  PubMed  Google Scholar 

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Funding

This work was supported by the NIHR Great Ormond Street Hospital Biomedical Research Centre. The Children’s Epilepsy Surgery Service at Great Ormond Street Hospital is part of the NHSE Specialised Commissioning national programme. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

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Authors and Affiliations

  1. Department of Paediatric Neurosurgery, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, UK

    Amparo Saenz & Martin M. Tisdall

  2. Department of Paediatric Neurology, University Hospitals Southampton NHS Trust, Southampton, UK

    Jaspal Singh

  3. Department of Endocrinology, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK

    Hoong-Wei Gan

  4. Epilepsy Unit, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK

    Sophia Monica Varadkar & Martin M. Tisdall

Authors
  1. Amparo Saenz
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  2. Jaspal Singh
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  3. Hoong-Wei Gan
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  4. Sophia Monica Varadkar
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  5. Martin M. Tisdall
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Contributions

All authors whose names appear on the submission made substantial contributions to the conception or design of the work; or the acquisition, analysis or interpretation of data; or the creation of new software used in the work.

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Correspondence to Amparo Saenz.

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The authors declare no competing interests.

Ethics approval and consent to participate

Ethical approval was waived by the local ethics committee of University A in view of the retrospective nature of the study and all the procedures being performed were part of the routine care. The study was conducted in accordance with the Declaration of Helsinki.

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We have consent from the parents of the patient to use his images and information for the purpose of this article.

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The authors have no relevant financial or non-financial interests to disclose.

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Saenz, A., Singh, J., Gan, HW. et al. A novel technique for frame-based MR-guided laser ablation in an infant. Childs Nerv Syst 39, 497–503 (2023). https://doi.org/10.1007/s00381-022-05616-2

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  • DOI: https://doi.org/10.1007/s00381-022-05616-2

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