MRI-guided laser interstitial thermal therapy using the Visualase system and Navigus frameless stereotaxy in an infant: technical case report

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  • 1 Department of Neurosurgery, Houston Methodist Hospital, Houston;
  • | 2 Departments of Neurology and
  • | 3 Neurosurgery, and
  • | 4 Mulva Clinic for the Neurosciences, Dell Medical School, University of Texas at Austin; and
  • | 5 Pediatric Neurosciences, Dell Children’s Medical Center of Central Texas, Austin, Texas
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Laser interstitial thermal therapy (LITT) is increasingly used as a surgical option for the treatment of epilepsy. Placement of the laser fibers relies on stereotactic navigation with cranial fixation pins. In addition, the laser fiber is stabilized in the cranium during the ablation using a cranial bolt that assumes maturity of the skull. Therefore, younger infants (< 2 years of age) have traditionally not been considered as candidates for LITT. However, LITT is an appealing option for patients with familial epilepsy syndromes, such as tuberous sclerosis complex (TSC), due to the multiplicity of lesions and the likely need for multiple procedures. A 4-month-old infant with TSC presented with refractory focal seizures despite receiving escalating doses of 5 antiepileptic medications. Electrographic and clinical seizures occurred numerous times daily. Noninvasive evaluations, including MRI, magnetoencephalography, scalp EEG, and SPECT, localized the ictal onset to a left frontal cortical tuber in the premotor area. In this paper, the authors report a novel technique to overcome the challenges of performing LITT in an infant with an immature skull by repurposing the Navigus biopsy skull mount for stereotactic placement of a laser fiber using electromagnetic-based navigation. The patient underwent successful ablation of the tuber and remained seizure free 4 months postoperatively. To the authors’ knowledge, this is the youngest reported patient to undergo LITT. A safe method is described to perform LITT in an infant using commonly available tools without dedicated instrumentation beyond standard stereotactic navigation, a biopsy platform, and the Visualase system.

ABBREVIATIONS

AED = antiepileptic drug; LITT = laser interstitial thermal therapy; MEG = magnetoencephalography; MRgLITT = MRI-guided LITT; TSC = tuberous sclerosis complex.
Images from Szuflita et al. (pp 28–33).

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Contributor Notes

Correspondence Winson S. Ho: Dell Children’s Medical Center of Central Texas, Austin, TX. winson.ho@austin.utexas.edu.

INCLUDE WHEN CITING Published online May 21, 2021; DOI: 10.3171/2020.11.PEDS20823.

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

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