gms | German Medical Science

73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

29.05. - 01.06.2022, Köln

Laser Interstitial Thermal Therapy (LITT) as a treatment option in drug resistant epilepsy

Laser Interstitielle Thermo Therapie (LITT) als Behandlungsoption in therapierefraktärer Epilepsie

Meeting Abstract

  • presenting/speaker Matthias Tomschik - Medizinische Universität Wien, Universitätsklinik für Neurochirurgie, Wien, Österreich
  • Johannes Herta - Medizinische Universität Wien, Universitätsklinik für Neurochirurgie, Wien, Österreich
  • Fabian Winter - Medizinische Universität Wien, Universitätsklinik für Neurochirurgie, Wien, Österreich
  • Jonathan Wais - Medizinische Universität Wien, Universitätsklinik für Neurochirurgie, Wien, Österreich
  • Martha Feucht - Medizinische Universität Wien, Pediatrics and Adolescent Medicine, Wien, Österreich
  • Christian Dorfer - Medizinische Universität Wien, Universitätsklinik für Neurochirurgie, Wien, Österreich
  • Karl Rössler - Medizinische Universität Wien, Universitätsklinik für Neurochirurgie, Wien, Österreich

Deutsche Gesellschaft für Neurochirurgie. 73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie. Köln, 29.05.-01.06.2022. Düsseldorf: German Medical Science GMS Publishing House; 2022. DocV155

doi: 10.3205/22dgnc153, urn:nbn:de:0183-22dgnc1530

Published: May 25, 2022

© 2022 Tomschik et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Objective: One third of patients with epilepsy do not achieve seizure freedom with medical therapy predisposing patients to a lower quality of life and especially in younger patients to cognitive deficits and developmental delays. Open epilepsy surgery can decrease seizure frequency or even cure patients but is often associated with cognitive deficits due to collateral surgical damage. Therefore, patients with deep seated lesions and those with lower chances of seizure freedom have traditionally been considered poor candidates for surgery. We aim to present how the use of LITT has challenged this assumption.

Methods: The Medtronic VisualaseTM system has been employed in the treatment of drug resistant epilepsy since January 2021. Laser fibers were implanted using a frameless stereotactic approach with or without robot guidance (Medtronic StealthStationTM S8 ± Stealth AutoguideTM). Patient data, lesion volume, ablation volume, surgical details and patient outcomes were recorded in a prospectively kept database and descriptively analyzed.

Results: During the first year of its use, we were able to treat ten patients, two adults and eight children, in eleven procedures. The most common indication was tuberous sclerosis associated epilepsy with multiple lesions, where the one or two most active tubera as determined by intracranial EEG recordings were targeted (seven procedures in six patients). Focal cortical dysplasias were targeted in two patients, periventricular heterotopias in one, and a MRI negative but electrographically active area in one patient. The mean lesion volume was 6.2 ± 4.9 cm3 and the mean ablation volume was 10.1 ± 4.5 cm3. All patients derived a clinical benefit from the procedures, which ranged from seizure reductions and developmental improvements in children with TSC to seizure freedom in adult cases, but the postoperative observation period is limited. Two patients had a transient hemiparesis and one patient suffers from hemianopsia due to the ablation.

Conclusion: LITT is a valuable tool in drug resistant epilepsy that allows minimally invasive ablation of deep-seated lesions. Due to the minimal trauma, it is suited for treatment of patients with low chances of seizure freedom where it can still produce major benefits for the patients. The procedure is however not risk free and proper planning is the fundamental requirement for success.