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“Laser and the Tuber”: thermal dynamic and volumetric factors influencing seizure outcomes in pediatric subjects with tuberous sclerosis undergoing stereoencephalography-directed laser ablation of tubers

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Abstract

Purpose

Tuberous sclerosis (TSC) is a well-known cause of medically refractory epilepsy (MRE). Stereoencephalography-directed magnetic resonance-guided laser interstitial thermal therapy (SEEG-directed MRgLITT) is an emerging minimally invasive technique that appears aptly suited for the surgical management of TSC. Our aims are to present our experiences with patients who had undergone SEEG-directed MRgLITT to identify and treat cortical tubers responsible for clinical seizures and to perform an in-depth analysis of volumetric and thermal dynamic factors that may be related to seizure outcomes.

Methods

We studied all pediatric patients with MRE due to TSC who underwent SEEG-directed MRgLITT, investigating seizure outcomes in relation to thermal dynamic and volumetric factors.

Results

Eight cortical tubers from three pediatric patients were analyzed. Two of three patients had Engel I outcomes at last follow-up (median 18 months). Average A/T (ablation volume/tuber volume) ratio for Engel I outcomes was 1.28 (variance, 0.16) and 0.84 (variance, < 0.01) for all other outcomes (P = 0.035). There was a moderate positive correlation when comparing ablation energy to ablation volume (R2 = 0.65) in cortical tuber tissue. When the calcified tuber is excluded, the correlation is stronger (R2 = 0.77). Thus, the calculated energy needed to ablate 1 cm3 of cortical tuber tissue is 1263.6 J (calcified tuber) or 1089.5 J (non-calcified tuber).

Conclusions

SEEG-directed MRgLITT appears to be a safe and effective technique in the management of pediatric patients with MRE due to TSC. The A/T ratio may be a useful indicator in predicting seizure outcomes.

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Authors and Affiliations

  1. Department of Neurosurgery, Children’s National Medical Center, Washington, DC, USA

    Michael A. Stellon, Kelsey Cobourn & Chima O. Oluigbo

  2. Department of Imaging and Diagnostic Radiology, Children’s National Medical Center, Washington, DC, USA

    Matthew T. Whitehead

  3. Tuberous Sclerosis Clinic, Department of Neurology, Children’s National Medical Center, Washington, DC, USA

    Nancy Elling & William McClintock

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  1. Michael A. Stellon
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Correspondence to Chima O. Oluigbo.

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Stellon, M.A., Cobourn, K., Whitehead, M.T. et al. “Laser and the Tuber”: thermal dynamic and volumetric factors influencing seizure outcomes in pediatric subjects with tuberous sclerosis undergoing stereoencephalography-directed laser ablation of tubers. Childs Nerv Syst 35, 1333–1340 (2019). https://doi.org/10.1007/s00381-019-04255-4

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