Corpus callosotomy performed with laser interstitial thermal therapy

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OBJECTIVE

Corpus callosotomy is a palliative procedure that is effective at reducing seizure burden in patients with medically refractory epilepsy. The procedure is traditionally performed via open craniotomy with interhemispheric microdissection to divide the corpus callosum. Concerns for morbidity associated with craniotomy can be a deterrent to patients, families, and referring physicians for surgical treatment of epilepsy. Laser interstitial thermal therapy (LITT) is a less invasive procedure that has been widely adopted in neurosurgery for the treatment of tumors. In this study, the authors investigated LITT as a less invasive approach for corpus callosotomy.

METHODS

The authors retrospectively reviewed all patients treated for medically refractory epilepsy by corpus callosotomy, either partial or completion, with LITT. Chart records were analyzed to summarize procedural metrics, length of stay, adverse events, seizure outcomes, and time to follow-up. In select cases, resting-state functional MRI was performed to qualitatively support effective functional disconnection of the cerebral hemispheres.

RESULTS

Ten patients underwent 11 LITT procedures. Five patients received an anterior two-thirds LITT callosotomy as their first procedure. One patient returned after LITT partial callosotomy for completion of callosotomy by LITT. The median hospital stay was 2 days (IQR 1.5–3 days), and the mean follow-up time was 1.0 year (range 1 month to 2.86 years). Functional outcomes are similar to those of open callosotomy, with the greatest effect in patients with a significant component of drop attacks in their seizure semiology. One patient achieved an Engel class II outcome after anterior two-thirds callosotomy resulting in only rare seizures at the 18-month follow-up. Four others were in Engel class III and 5 were Engel class IV. Hemorrhage occurred in 1 patient at the time of removal of the laser fiber, which was placed through the bone flap of a prior open partial callosotomy.

CONCLUSIONS

LITT appears to be a safe and effective means for performing corpus callosotomy. Additional data are needed to confirm equipoise between open craniotomy and LITT for corpus callosotomy.

ABBREVIATIONS CC = corpus callosum; DWI = diffusion-weighted imaging; FC = functional connectivity; iMRI = intraoperative MRI; LITT = laser interstitial thermal therapy; MRE = medically refractory epilepsy; rs-fMRI = resting-state functional MRI; TDE = thermal damage estimate.
Article Information

Contributor Notes

Correspondence Jarod L. Roland: University of California, San Francisco, CA. jarod.roland@ucsf.edu.INCLUDE WHEN CITING Published online December 13, 2019; DOI: 10.3171/2019.9.JNS191769.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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