Abstract Details

Title Minimally Invasive Stereotactic Laser Ablation (SLA) of Hypothalamic Hamartomas (HH)

Topic Epilepsy/Clinical Neurophysiology (EEG)

Presentation(s) S48 - (-)

Poster/Presentation
Number 002

Objective

Background Surgical intervention for HH has been limited due to modest outcomes (37- 50% seizure freedom), difficult location, and associated surgical morbidity (7-10% permanent). Stereotactic radiosurgery has also demonstrated modest results. Seizures are primarily gelastic, medically intractable and may occur every few minutes. Patients often develop progressive intellectual deterioration and disordered behavior.

Design/Methods Patients (n=13 ped:11 adult:2) with intractable gelastic epilepsy underwent stereotactic frame-based placement of MR-compatible laser catheter (1.6mm dia) through a 3.2mm twist drill hole. An FDA-cleared laser surgery system (Visualase; Visualase, Inc., Houston, TX) was utilized to monitor the ablation of epileptogenic foci with real-time MRI thermometry. After confirmation test at [sim] 3W, higher doses of 6-10 W for 50-120 seconds were used for SLA. Temperature limits were set to protect nearby structures like the hypothalamus, basilar artery, fornices, or mamillothalamic tracts.

Results There were no permanent surgical complications, neurological deficits, or neuroendocrine disturbances. One pt had transient DI, another with prolonged hospitalization after dilantin toxicity, and another with a minor subarachnoid hemorrhage. The average LOS was 2 days. Seizure freedom was obtained in 8 of the 13 cases (61%), 72% in the pediatric patients. Engel 1 status was achieved in 2 of the 3 cases.

Conclusions SLA was demonstrated to be a safe and effective minimally invasive tool to treat HH. Seizure freedom was achieved without surgical comorbidity and reduced LOS. Real-time MRI thermometry enabled protection of adjacent critical structures. The best results from treatment of the HH will likely result if the treatment occurs before the evolution of the seizure pattern into a widespread secondary generalized epilepsy. SLA provides a precise minimally invasive tool in the neurosurgeon's armamentarium for first-line intervention and in cases where SRS and surgery have failed.

Authors/Disclosures
Daniel Curry, MD PRESENTER	No disclosure on file
Angus Wilfong, MD (Pediatric Neurology)	No disclosure on file
Gregory D. Cascino, MD, FAAN (Mayo Clinic)	Dr. Cascino has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for International League Against Epilepsy . Dr. Cascino has received intellectual property interests from a discovery or technology relating to health care. Dr. Cascino has received publishing royalties from a publication relating to health care. Dr. Cascino has received publishing royalties from a publication relating to health care.
Gregory A. Worrell, MD (Mayo Clinic College of Medicine)	Dr. Worrell has received stock or an ownership interest from NeuroOne Inc.. Dr. Worrell has received stock or an ownership interest from Cadence Neuroscience Inc. The institution of Dr. Worrell has received research support from NIH. The institution of Dr. Worrell has received research support from Medtronic Inc.. The institution of Dr. Worrell has received research support from Neuropace Inc,. The institution of Dr. Worrell has received research support from Epilepsy Foundation of America. Dr. Worrell has received intellectual property interests from a discovery or technology relating to health care. Dr. Worrell has received intellectual property interests from a discovery or technology relating to health care.
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
Masanori Takeoka, MD (Children'S Hospital Boston)	No disclosure on file
	No disclosure on file
Anil Shetty, MBBS	No disclosure on file

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