Magnetic resonance imaging–guided laser-induced thermal therapy for functional hemispherotomy in a child with refractory epilepsy and multiple medical comorbidities

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  • 1 Department of Neurosurgery, Brigham and Women’s Hospital/Harvard Medical School, Boston;
  • 2 Department of Neurosurgery, Boston Children’s Hospital/Harvard Medical School, Boston; and
  • 3 Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children’s Hospital/Harvard Medical School, Boston, Massachusetts
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Magnetic resonance imaging–guided laser-induced thermal therapy (MRgLITT) is a minimally invasive surgical approach increasingly employed for precise targeted ablation of epileptogenic brain foci. Recent reports have described corpus callosotomy using MRgLITT, though its application in more extensive functional disconnections has not been documented. Here, the authors detail its use in achieving a palliative hemispherotomy in a 5-year-old with medically refractory hemiclonic seizures following a hemispheric infarction, highlighting a novel use of this surgical technique. In this particular case, open craniotomy was deemed high risk given the multiple medical comorbidities including congenital cardiac disease and end-stage renal failure. MRgLITT was considered an alternative approach with a lower risk for periprocedural hemodynamic perturbations. The patient tolerated the procedure well, attaining an Engel class IB outcome at 16 months’ follow-up. This suggests that MRgLITT may be an alternative approach to an open hemispherectomy, particularly in cases in which multiple comorbidities pose significant risks and preclude an open procedure.

ABBREVIATIONS EEG = electroencephalography; MCA = middle cerebral artery; MRgLITT = magnetic resonance imaging–guided laser-induced thermal therapy; POD = postoperative day.

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Contributor Notes

Correspondence Scellig Stone: Boston Children’s Hospital/Harvard Medical School, Boston, MA. scellig.stone@childrens.harvard.edu.

INCLUDE WHEN CITING Published online October 23, 2020; DOI: 10.3171/2020.6.PEDS20455.

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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