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https://www.readbyqxmd.com/read/28096104/recent-developments-in-the-surgical-management-of-paediatric-epilepsy
#1
REVIEW
Vijay M Ravindra, Matthew T Sweney, Robert J Bollo
Among the 1% of children affected by epilepsy, failure of pharmacological therapy and early age of seizure onset can lead to worse long-term cognitive outcomes, mental health disorders and impaired functional status. Surgical management often improves functional and cognitive outcomes in children with medically refractory epilepsy, especially when seizure remission is achieved. However, surgery remains underused in children with drug-resistant epilepsy, creating a large treatment gap. Several recent innovations have led to considerable improvement in surgical technique, including the recent development of minimally invasive diagnostic and therapeutic techniques such as stereotactic EEG, transcranial magnetic stimulation, MRI-guided laser ablation, as well as novel paradigms of neurostimulation...
January 17, 2017: Archives of Disease in Childhood
https://www.readbyqxmd.com/read/27995127/stereotactic-laser-ablation-for-medically-intractable-epilepsy-the-next-generation-of-minimally-invasive-epilepsy-surgery
#2
REVIEW
Michael J LaRiviere, Robert E Gross
Epilepsy is a common, disabling illness that is refractory to medical treatment in approximately one-third of patients, particularly among those with mesial temporal lobe epilepsy. While standard open mesial temporal resection is effective, achieving seizure freedom in most patients, efforts to develop safer, minimally invasive techniques have been underway for over half a century. Stereotactic ablative techniques, in particular, radiofrequency (RF) ablation, were first developed in the 1960s, with refinements in the 1990s with the advent of modern computed tomography and magnetic resonance-based imaging...
2016: Frontiers in Surgery
https://www.readbyqxmd.com/read/27959970/magnetic-resonance-thermometry-guided-stereotactic-laser-ablation-of-cavernous-malformations-in-drug-resistant-epilepsy-imaging-and-clinical-results
#3
D Jay McCracken, Jon T Willie, Brad Fernald, Amit M Saindane, Daniel L Drane, Daniel L Barrow, Robert E Gross
BACKGROUND: Surgery is indicated for cerebral cavernous malformations (CCM) that cause medically refractory epilepsy. Real-time magnetic resonance thermography (MRT)-guided stereotactic laser ablation (SLA) is a minimally invasive approach to treating focal brain lesions. SLA of CCM has not previously been described. OBJECTIVE: To describe MRT-guided SLA, a novel approach to treating CCM-related epilepsy, with respect to feasibility, safety, imaging, and seizure control in 5 consecutive patients...
March 2016: Operative Neurosurgery (Hagerstown, Md.)
https://www.readbyqxmd.com/read/27861324/laser-ablation-of-recurrent-malignant-gliomas-current-status-and-future-perspective
#4
Analiz Rodriguez, Stephen B Tatter
: Recurrent malignant glioma continues to be a clinical challenge, and repeat surgery is an option in only select patients. Stereotactic laser ablation, a new minimally invasive technique, can be used as an alternative to surgery. We review the current literature on laser ablation for recurrent malignant gliomas as well as discuss practical and theoretical advantages and disadvantages of this emerging technique in comparison with repeat surgery or radiation. We also discuss the potential for laser ablation to augment adjuvant therapies, namely, chemotherapy, radiation, and immunotherapy...
December 2016: Neurosurgery
https://www.readbyqxmd.com/read/27861323/stereotactic-laser-interstitial-thermal-therapy-for-recurrent-high-grade-gliomas
#5
Ian Lee, Steven Kalkanis, Constantinos G Hadjipanayis
BACKGROUND: The value of maximal safe cytoreductive surgery in recurrent high-grade gliomas (HGGs) is gaining wider acceptance. However, patients may harbor recurrent tumors that may be difficult to access with open surgery. Laser interstitial thermal therapy (LITT) is emerging as a technique for treating a variety of brain pathologies, including primary and metastatic tumors, radiation necrosis, and epilepsy. OBJECTIVE: To review the role of LITT in the treatment of recurrent HGGs, for which current treatments have limited efficacy, and to discuss the possible role of LITT in the disruption of the blood-brain barrier to increase delivery of chemotherapy locoregionally...
December 2016: Neurosurgery
https://www.readbyqxmd.com/read/27861321/laser-interstitial-thermal-therapy-technology-physics-of-magnetic-resonance-imaging-thermometry-and-technical-considerations-for-proper-catheter-placement-during-magnetic-resonance-imaging-guided-laser-interstitial-thermal-therapy
#6
Nitesh V Patel, Matthew Mian, R Jason Stafford, Brian V Nahed, Jon T Willie, Robert E Gross, Shabbar F Danish
: Laser-induced thermal therapy has become a powerful tool in the neurosurgical armamentarium. The physics of laser therapy are complex, but a sound understanding of this topic is clinically relevant, as many centers have incorporated it into their treatment algorithm, and educated patients are demanding consideration of its use for their disease. Laser ablation has been used for a wide array of intracranial lesions. Laser catheter placement is guided by stereotactic planning; however, as the procedure has popularized, the number of ways in which the catheter can be inserted has also increased...
December 2016: Neurosurgery
https://www.readbyqxmd.com/read/27742372/a-novel-combination-of-two-minimally-invasive-surgical-techniques-in-the-management-of-refractory-radiation-necrosis-technical-note
#7
Ghaith Habboub, Mayur Sharma, Gene H Barnett, Alireza M Mohammadi
BACKGROUND: Minimally-invasive approaches are attractive alternative to standard craniotomy for large intracranial tumors with potentially lesser morbidity. In this report, we describe a sequential combination of two minimally-invasive surgical techniques to treat a large intracranial tumor. CLINICAL PRESENTATION: A 49year-old woman presented with a history of breast cancer and large left parietal metastasis with significant perilesional edema. This was initially managed by whole brain radiation therapy and stereotactic radiosurgery...
January 2017: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/27690660/stereotactic-robot-assisted-mri-guided-laser-thermal-ablation-of-radiation-necrosis-in-the-posterior-cranial-fossa-technical-note
#8
Alvin Y Chan, Diem Kieu T Tran, Amandip S Gill, Frank P K Hsu, Sumeet Vadera
Laser interstitial thermal therapy (LITT) is a minimally invasive procedure used to treat a variety of intracranial lesions. Utilization of robotic assistance with stereotactic procedures has gained attention due to potential for advantages over conventional techniques. The authors report the first case in which robot-assisted MRI-guided LITT was used to treat radiation necrosis in the posterior fossa, specifically within the cerebellar peduncle. The use of a stereotactic robot allowed the surgeon to perform LITT using a trajectory that would be extremely difficult with conventional arc-based techniques...
October 2016: Neurosurgical Focus
https://www.readbyqxmd.com/read/27690658/laser-interstitial-thermal-therapy-followed-by-minimal-access-transsulcal-resection-for-the-treatment-of-large-and-difficult-to-access-brain-tumors
#9
James Wright, Jessey Chugh, Christina Huang Wright, Fernando Alonso, Alia Hdeib, Haley Gittleman, Jill Barnholtz-Sloan, Andrew E Sloan
OBJECTIVE Laser interstitial thermal therapy (LITT), sometimes referred to as "stereotactic laser ablation," has demonstrated utility in a subset of high-risk surgical patients with difficult to access (DTA) intracranial neoplasms. However, the treatment of tumors larger than 10 cm(3) is associated with suboptimal outcomes and morbidity. This may limit the utility of LITT in dealing with precisely those large or deep tumors that are most difficult to treat with conventional approaches. Recently, several groups have reported on minimally invasive transsulcal approaches utilizing tubular retracting systems...
October 2016: Neurosurgical Focus
https://www.readbyqxmd.com/read/27690656/stereotactic-laser-ablation-for-hypothalamic-and-deep-intraventricular-lesions
#10
Robert T Buckley, Anthony C Wang, John W Miller, Edward J Novotny, Jeffrey G Ojemann
OBJECTIVE Laser ablation is a novel, minimally invasive procedure that utilizes MRI-guided thermal energy to treat epileptogenic and other brain lesions. In addition to treatment of mesial temporal lobe epilepsy, laser ablation is increasingly being used to target deep or inoperable lesions, including hypothalamic hamartoma (HH), subependymal giant cell astrocytoma (SEGA), and exophytic intrinsic hypothalamic/third ventricular tumors. The authors reviewed their early institutional experience with these patients to characterize clinical outcomes in patients undergoing this procedure...
October 2016: Neurosurgical Focus
https://www.readbyqxmd.com/read/27690655/percutaneous-surgery-for-treatment-of-epidural-spinal-cord-compression-and-spinal-instability-technical-note
#11
Claudio E Tatsui, Telmo A B Belsuzarri, Marilou Oro, Laurence D Rhines, Jing Li, Amol J Ghia, Behrang Amini, Heron Espinoza, Paul D Brown, Ganesh Rao
OBJECTIVE An emerging paradigm for treating patients with epidural spinal cord compression (ESCC) caused by metastatic tumors is surgical decompression and stabilization, followed by stereotactic radiosurgery. In the setting of rapid progressive disease, interruption or delay in return to systemic treatment can lead to a negative impact in overall survival. To overcome this limitation, the authors introduce the use of spinal laser interstitial thermotherapy (sLITT) in association with percutaneous spinal stabilization to facilitate a rapid return to oncological treatment...
October 2016: Neurosurgical Focus
https://www.readbyqxmd.com/read/27690654/stereotactic-laser-ablation-as-treatment-for-brain-metastases-that-recur-after-stereotactic-radiosurgery-a-multiinstitutional-experience
#12
Mir Amaan Ali, Kate T Carroll, Robert C Rennert, Thomas Hamelin, Leon Chang, Brian P Lemkuil, Mayur Sharma, Jill S Barnholtz-Sloan, Charlotte Myers, Gene H Barnett, Kris Smith, Alireza M Mohammadi, Andrew E Sloan, Clark C Chen
OBJECTIVE Therapeutic options for brain metastases (BMs) that recur after stereotactic radiosurgery (SRS) remain limited. METHODS The authors provide the collective experience of 4 institutions where treatment of BMs that recurred after SRS was performed with stereotactic laser ablation (SLA). RESULTS Twenty-six BMs (in 23 patients) that recurred after SRS were treated with SLA (2 patients each underwent 2 SLAs for separate lesions, and a third underwent 2 serial SLAs for discrete BMs). Histological findings in the BMs treated included the following: breast (n = 6); lung (n = 6); melanoma (n = 5); colon (n = 2); ovarian (n = 1); bladder (n = 1); esophageal (n = 1); and sarcoma (n = 1)...
October 2016: Neurosurgical Focus
https://www.readbyqxmd.com/read/27690652/utilizing-personalized-stereotactic-frames-for-laser-interstitial-thermal-ablation-of-posterior-fossa-and-mesiotemporal-brain-lesions-a-single-institution-series
#13
David Y A Dadey, Ashwin A Kamath, Matthew D Smyth, Michael R Chicoine, Eric C Leuthardt, Albert H Kim
OBJECTIVE The precision of laser probe insertion for interstitial thermal therapy of deep-seated lesions is limited by the method of stereotactic guidance. The objective of this study was to evaluate the feasibility of customized STarFix 3D-printed stereotactic platforms to guide laser probe insertion into mesiotemporal and posterior fossa targets. METHODS The authors conducted a retrospective review of 5 patients (12-55 years of age) treated with laser interstitial thermal therapy (LITT) in which STarFix platforms were used for probe insertion...
October 2016: Neurosurgical Focus
https://www.readbyqxmd.com/read/27690651/magnetic-resonance-imaging-guided-laser-interstitial-thermal-therapy-for-previously-treated-hypothalamic-hamartomas
#14
Anthony M Burrows, W Richard Marsh, Gregory Worrell, David A Woodrum, Bruce E Pollock, Krzysztof R Gorny, Joel P Felmlee, Robert E Watson, Timothy J Kaufmann, Steven Goerss, Jamie J Van Gompel
OBJECTIVE Hypothalamic hamartomas (HHs) are associated with gelastic seizures and the development of medically refractory epilepsy. Magnetic resonance imaging-guided laser interstitial thermal therapy (MRg-LITT) is a minimally invasive ablative treatment that may have applicability for these deep-seated lesions. Here, the authors describe 3 patients with refractory HHs who they treated with MRg-LITT. METHODS An institutional review board-approved prospective database of patients undergoing Visualase MRg-LITT was retrospectively reviewed...
October 2016: Neurosurgical Focus
https://www.readbyqxmd.com/read/27690649/the-use-of-custom-3d-printed-stereotactic-frames-for-laser-interstitial-thermal-ablation-technical-note
#15
Nicholas J Brandmeir, James McInerney, Brad E Zacharia
Over the last several years, laser interstitial thermotherapy (LITT) has gained wide acceptance for the treatment of a myriad of cranial lesions. A wide variety of techniques for placement of the laser fiber have been reported with a spectrum of perceived benefits and drawbacks. The authors present the first report of a customized 3D printed stereotactic frame for LITT. Approximately 1 week prior to surgery, 3-4 skull fiducials were placed after each of 5 patients received a local anesthetic as an outpatient...
October 2016: Neurosurgical Focus
https://www.readbyqxmd.com/read/27690648/safety-of-stereotactic-laser-ablations-performed-as-treatment-for-glioblastomas-in-a-conventional-magnetic-resonance-imaging-suite
#16
Robert C Rennert, Kate T Carroll, Mir Amaan Ali, Thomas Hamelin, Leon Chang, Brian P Lemkuil, Clark C Chen
OBJECTIVE Stereotactic laser ablation (SLA) is typically performed in the setting of intraoperative MRI or in a staged manner in which probe insertion is performed in the operating room and thermal ablation takes place in an MRI suite. METHODS The authors describe their experience, in which SLA for glioblastoma (GBM) treatment was performed entirely within a conventional MRI suite using the SmartFrame stereotactic device. RESULTS All 10 patients with GBM (2 with isocitrate dehydrogenase 1 mutation [mIDH1] and 8 with wild-type IDH1 [wtIDH1]) were followed for > 6 months...
October 2016: Neurosurgical Focus
https://www.readbyqxmd.com/read/27399482/203%C3%A2-insular-depth-electrode-in-pediatric-treatment-refractory-epilepsy
#17
Luke Tomycz, Ali Haider, Maura Hamilton, David B Clarke, Mark R Lee
INTRODUCTION: It has been increasingly recognized that the insular cortex plays an important role in frontotemporal epilepsy (FTE) in children. The insula, however, cannot properly by monitored with conventional subdural grids, and open surgical resection of the insula is technically difficult and often associated with significant morbidity. Stereotactically placed insular depth electrodes allow direct and comprehensive monitoring of this region, and can easily be replaced with a laser applicator for minimally invasive treatment via thermo-ablation...
August 2016: Neurosurgery
https://www.readbyqxmd.com/read/27261642/intraoperative-ecog-during-mri-guided-laser-interstitial-thermal-therapy-for-intractable-epilepsy
#18
Matthew W Luedke, Michael R Pietak, Sandra Serafini, Michael M Haglund, Saurabh R Sinha
MRI-guided laser-interstitial thermal therapy is a new modality for epilepsy surgery. In patients with intractable localization-related seizures, it has been used to ablate epileptogenic lesions with less morbidity than conventional craniotomies, and with potentially similar rates of seizure freedom. It is gaining favor in the treatment of mesial temporal sclerosis, in which the circumscribed epileptic focus is amenable to a stereotactic approach. In some centers, intraoperative electrocorticography (ECoG) is a standard procedure during tailored temporal lobectomies that include resection of mesial temporal structures...
August 2016: Journal of Clinical Neurophysiology: Official Publication of the American Electroencephalographic Society
https://www.readbyqxmd.com/read/27234607/staged-laser-interstitial-thermal-therapy-and-topectomy-for-complete-obliteration-of-complex-focal-cortical-dysplasias
#19
Jason A Ellis, Juan C Mejia Munne, Shih-Hsiu Wang, Danielle K McBrian, Cigdem I Akman, Neil A Feldstein, Guy M McKhann
Anatomically complex focal cortical dysplasias may present significant challenges to safe and complete surgical resection via standard operative corridors. Laser interstitial thermal therapy (LITT) is an emerging minimally invasive technique that may address some of these challenges, enabling stereotactic ablation of deep and/or surgically inaccessible regions. However, complete ablation may not be feasible in all cases. To address this dilemma, we have designed a protocol utilizing staged LITT followed by topectomy to effect complete obliteration of a complex focal cortical dysplasia...
September 2016: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/27217984/robot-assisted-stereotactic-laser-ablation-for-a-radiosurgery-resistant-hypothalamic-hamartoma
#20
Nicholas Brandmeir, Vinita Acharya, Michael Sather
Hypothalamic hamartomas (HH) are benign tumors that can cause significant morbidity in adults as a cause of epilepsy, particularly gelastic seizures. Open and endoscopic resections of HH offer good seizure control but have high rates of morbidity and are technically challenging. Stereotactic radiosurgery has been an alternative treatment; however, it results in comparably poor seizure control. Recently, in children, stereotactic laser ablation has shown promise as a surgical technique that can combine the best features of both of these approaches for the treatment of HH...
2016: Curēus
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