(Abst. 1.278 ), 2012
LASER ABLATION OF NON-MESIAL TEMPORAL FOCI WITH MEG LOCALIZATION AND SURFACE EEG RECORDING DURING MRI GUIDED ABLATION: FOUR PEDIATRIC CASES WITH EEG NORMALIZATION POST-LASER ABLATION
Authors: M. G. Chez, S. Ciricillo, A. Ghasseimi, C. Lepage, H. E. Kirsch, S. M. Honma, M. M. Mantle Instit: Sutter Neuroscience Medical Group
Epilepsy surgery may be the long term best solution for patients with refractive epilepsy. Current guidelines suggest that earlier surgery is better and reduces long term comorbidity. Often patients fear the process of craniotomy and surgical removal or brain tissue. The fear of procedure , longer hospital stays, and often difficult to treat extra-temporal foci lead to many not feeling they have a surgical option. We present a new less invasive technique with non-invasive localization using surface EEG, MEG(Magnetoencephalography) and fMRI combined with Brainlab Localization. This yields minimally invasive MRI guided ablation and shortened hospital stay and recovery in less than 24 hours . We present 4 cases.
Four pediatric refractory epilepsy patients with focal origin were evaluated with video EEG, fMRI, MEG( and 3 tessla MRI using Brainlab localization (Table). Patients deemed focal in origin had 3 frontal and one superior temporal gyrus localizations with refractive EEG and seizure control affecting behavior, Patients were 2 males ( age 11, 8) and 2 females age (19 and age 14). Three patients had autism spectrum or cognitive disability making standard intracranial grid mapping and craniotomy less desirable. These patients elected to have laser ablation with Brainlab guided laser placement. All had MRI compatable plastic electrodes during MRI guidance of laser ablation showing pre-ablation and post-ablation spike data.as a method of intraoperative EEG monitoring. Laser system was from Visualase . MEG scan was performed at UCSF Biomagnetic iIImaging Center
All 4 patients underwent SLA at Sutter Medical Center Sacramento between 11-11and 6-12 (Picture). All patients showed resolution of pre-ablation spikes on intraprocedure EEG taken immediately post ablation. . Patients were pain free, eating, and ambulatory within 6-8 hours post-ablation and discharged after less than 24 hours. .. Patients were seen after 1-2 weeks, and the first patient monitored for 6 months post-operatively, remains seizure free off medications with memory and language improvement. 19 yr old with Noonan Syndrome and spikes along superior temporal gyrus had a reduction from 4 seizures per day to 2-3 seizures per week initially, then became less than1per week , while 3 frontal localized seizures remained seizure free with one already tapered off medications with normal EEG.
.SLA may offer an attractive option for deep non-mesial temporal and non-lesional epileptic foci to be surgically destroyed with minimal risk and invasiveness. This technique can be combined with MEG spike data fused to MRI, and intraprocedural MRI-compatible surface EEG recordings to monitor successful ablation of refractive focal epileptic zones. More studies showing long term efficacy and reduction in drug burden is recommended.
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