Corpus callosotomy via laser interstitial thermal therapy: a case series

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Corpus callosotomy has been used as a form of surgical palliation for patients suffering from medically refractory generalized seizures, including drop attacks. Callosotomy has traditionally been described as involving a craniotomy with microdissection. MR-guided laser interstitial thermal therapy (MRg-LITT) has recently been used as a minimally invasive method for performing surgical ablation of epileptogenic foci and corpus callosotomy. The authors present 3 cases in which MRg-LITT was used to perform a corpus callosotomy as part of a staged surgical procedure for a patient with multiple seizure types and in instances when further ablation of residual corpus callosum is necessary after a prior open surgical procedure. To the authors’ knowledge, this is the first case series of corpus callosotomy performed using the MRg-LITT system with a 3.3-year average follow-up. Although MRg-LITT is not expected to replace the traditional corpus callosotomy in all cases, it is a safe, effective, and durable alternative to the traditional open corpus callosotomy, particularly in the setting of a prior craniotomy.

ABBREVIATIONS cVEEG = continuous video electroencephalography; MRg-LITT = MR-guided laser interstitial thermal therapy; OR = operating room.

Article Information

Correspondence Atilio E. Palma: Wake Forest University School of Medicine, Winston-Salem, NC. apalma@wakehealth.edu.

INCLUDE WHEN CITING Published online December 21, 2018; DOI: 10.3171/2018.10.PEDS18368.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

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Figures

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    MRI sequences of the brain. A: Sagittal T1-weighted image showing laser catheter trajectory on the body of the corpus callosum. B: Sagittal T1-weighted image showing laser catheter trajectory through the rostrum of the corpus callosum. C: Axial T1-weighted image showing laser catheter trajectory through the body of the corpus callosum. D: Axial T1-weighted image with addition of contrast showing part of the area of thermal ablation of the corpus callosum.

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    MRI sequences of the brain. A: Oblique T2-weighted view of the laser catheter trajectory through the genu of the corpus callosum. B: Axial T2-weighted image showing the laser catheter trajectory through the body of the corpus callosum. C: Sagittal T2-weighted image showing the laser catheter trajectory through the body of the corpus callosum and ending in the splenium. D: Axial T1-weighted image obtained after addition of contrast showing a portion of the area of thermal ablation in the corpus callosum.

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    MRI sequences of the brain. A: Axial T1-weighted image obtained after addition of contrast showing the laser catheter trajectory through the splenium of the corpus callosum. B: Sagittal T1-weighted image obtained after addition of contrast showing the laser catheter trajectory through the splenium of the corpus callosum. C: Axial T1-weighted image obtained after addition of contrast showing part of the area of thermal ablation within the region of the splenium of the corpus callosum.

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