Laser thermal ablation in epilepsy

ABSTRACT

Introduction:Many different types of surgical procedures are available for patients with drug-resistant epilepsy. MRI-guided laser interstitial thermal therapy is a stereotactic procedure with the potential to provide excellent seizure outcomes, while minimizing surgical approach related complications.

Areas covered:This review will cover the role of MRgLITT in the treatment of multiple facets of epilepsy including temporal lobe epilepsy, nodular heterotopias, hypothalamic hamartomas, as well as corpus Callosotomy.

Expert opinion:The development of magnetic resonance thermography has advanced continuous monitoring of thermal tissue destruction of pathological tissue in near real-time to allow for individualized neurological care for a person with epilepsy. Overall the results of MRgLITT appear similar to larger open forms of epilepsy surgery though with the promise of a safer side-effect profile. To improve this technique we must develop intraoperative biomarkers of procedural success, and develop tools to improve our patient selection.

KEYWORDS:

• Stereotactic
• laser
• interstitial
• thermal
• therapy
• ablation
• surgery
• epilepsy
• seizures

Article highlights

• MRgLITT permits precise thermal ablation of targeted tissue in the brain, through a tiny burr hole with a scalp incision of 1 cm.

• Safety profile has been excellent with adverse neurocognitive deficits appearing minimal yet with efficacy similar to resective surgery.

• Most have same-day surgery and leave the hospital within 24 h of the procedure.

• A minimally invasive approach may be attractive to patients and physicians and increase the pool of surgical candidates.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.