TY - JOUR
T1 - Magnetic resonance thermometry-guided stereotactic laser ablation of cavernous malformations in drug-resistant epilepsy
T2 - Imaging and clinical results
AU - McCracken, D. Jay
AU - Willie, Jon T.
AU - Fernald, Brad A.
AU - Saindane, Amit M.
AU - Drane, Daniel L.
AU - Barrow, Daniel L.
AU - Gross, Robert E.
N1 - Funding Information:
Funding was provided to Emory University by way of a clinical study agreement from Visualase, Inc., which developed products related to the research described in this article. In addition, Dr Gross served as a consultant to Visualase, Inc. and Medtronic, Inc. and received compensation for these services. The terms of this arrangement have been reviewed and approved by Emory University in accordance with its conflict of interest policies. B. Femald is a former employee and stockholder in Visualase, Inc. Dr Drane receives funding from the NIH/NINDS (K02 NS070960), which provides support for his work. Dr Willie is a consultant for Medtronic, Inc. and MRI Interventions, Inc. The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article.
Publisher Copyright:
Copyright © 2016 by the Congress of Neurological Surgeons.
PY - 2016
Y1 - 2016
N2 - BACKGROUND: Surgery is indicated for cerebral cavernous malformations (CCMs) that cause medically refractory epilepsy. Real-time magnetic resonance thermography (MRT)-guided stereotactic laser ablation (SLA) is a minimally invasive approach to treating focal brain lesions. SLA of CCM has not previously been described. OBJECTIVE: To describe MRT-guided SLA, a novel approach to treating CCM-related epilepsy, with respect to feasibility, safety, imaging, and seizure control in 5 consecutive patients. METHODS: Five patients with medically refractory epilepsy undergoing standard presurgical evaluation were found to have corresponding lesions fulfilling imaging characteristics of CCM and were prospectively enrolled. Each underwent stereotactic placement of a saline-cooled cannula containing an optical fiber to deliver 980-nm diode laser energy via twist drill craniostomy. MR anatomic imaging was used to evaluate targeting before ablation. MR imaging provided evaluation of targeting and near real-time feedback regarding the extent of tissue thermocoagulation. Patients maintained seizure diaries, and remote imaging (6-21 months postablation) was obtained in all patients. RESULTS: Imaging revealed no evidence of acute hemorrhage following fiber placement within presumed CCM. MRT during treatment and immediate postprocedure imaging confirmed the desired extent of ablation. We identified no adverse events or neurological deficits. Four of 5 (80%) patients achieved freedom from disabling seizures after SLA alone (Engel class 1 outcome), with follow-up ranging 12 to 28 months. Reimaging of all subjects (6-21 months) indicated lesion diminution with surrounding liquefactive necrosis, consistent with the surgical goal of extended lesionotomy. CONCLUSION: Minimally invasive MRT-guided SLA of epileptogenic CCM is a potentially safe and effective alternative to open resection. Additional experience and longer follow-up are needed.
AB - BACKGROUND: Surgery is indicated for cerebral cavernous malformations (CCMs) that cause medically refractory epilepsy. Real-time magnetic resonance thermography (MRT)-guided stereotactic laser ablation (SLA) is a minimally invasive approach to treating focal brain lesions. SLA of CCM has not previously been described. OBJECTIVE: To describe MRT-guided SLA, a novel approach to treating CCM-related epilepsy, with respect to feasibility, safety, imaging, and seizure control in 5 consecutive patients. METHODS: Five patients with medically refractory epilepsy undergoing standard presurgical evaluation were found to have corresponding lesions fulfilling imaging characteristics of CCM and were prospectively enrolled. Each underwent stereotactic placement of a saline-cooled cannula containing an optical fiber to deliver 980-nm diode laser energy via twist drill craniostomy. MR anatomic imaging was used to evaluate targeting before ablation. MR imaging provided evaluation of targeting and near real-time feedback regarding the extent of tissue thermocoagulation. Patients maintained seizure diaries, and remote imaging (6-21 months postablation) was obtained in all patients. RESULTS: Imaging revealed no evidence of acute hemorrhage following fiber placement within presumed CCM. MRT during treatment and immediate postprocedure imaging confirmed the desired extent of ablation. We identified no adverse events or neurological deficits. Four of 5 (80%) patients achieved freedom from disabling seizures after SLA alone (Engel class 1 outcome), with follow-up ranging 12 to 28 months. Reimaging of all subjects (6-21 months) indicated lesion diminution with surrounding liquefactive necrosis, consistent with the surgical goal of extended lesionotomy. CONCLUSION: Minimally invasive MRT-guided SLA of epileptogenic CCM is a potentially safe and effective alternative to open resection. Additional experience and longer follow-up are needed.
KW - Cavernous malformation
KW - Epilepsy
KW - Laser therapy
KW - Magnetic resonance imaging
KW - Minimally invasive surgical procedures
KW - Stereotactic techniques
KW - Thermometry
UR - http://www.scopus.com/inward/record.url?scp=85017359567&partnerID=8YFLogxK
U2 - 10.1227/NEU.0000000000001033
DO - 10.1227/NEU.0000000000001033
M3 - Article
C2 - 27959970
AN - SCOPUS:85017359567
SN - 2332-4252
VL - 12
SP - 39
EP - 48
JO - Operative Neurosurgery
JF - Operative Neurosurgery
IS - 4
ER -