Abstract
Anterior two-thirds corpus callosotomy is an effective palliative neurosurgical procedure for drug-refractory epilepsy that is most commonly used to treat drop-attacks. Laser interstitial thermal therapy is a novel stereotactic ablative technique that has been utilised as a minimally invasive alternative to resective and disconnective open neurosurgery. Case series have reported success in performing laser anterior two-thirds corpus callosotomy. Computer-assisted planning algorithms may help to automate and optimise multi-trajectory planning for this procedure. To undertake a simulation-based feasibility study of computer-assisted corpus callostomy planning in comparison with expert manual plans in the same patients. Ten patients were selected from a prospectively maintained database. Patients had previously undergone diffusion-weighted imaging and digital subtraction angiography as part of routine SEEG care. Computer-assisted planning was performed using the EpiNav™ platform and compared to manually planned trajectories from two independent blinded experts. Estimated ablation cavities were used in conjunction with probabilistic tractography to simulate the expected extent of interhemispheric disconnection. Computer-assisted planning resulted in significantly improved trajectory safety metrics (risk score and minimum distance to vasculature) compared to blinded external expert manual plans. Probabilistic tractography revealed residual interhemispheric connectivity in 1/10 cases following computer-assisted planning compared to 4/10 and 2/10 cases with manual planning. Computer-assisted planning successfully generates multi-trajectory plans capable of LITT anterior two-thirds corpus callosotomy. Computer-assisted planning may provide a means of standardising trajectory planning and serves as a potential new tool for optimising trajectories. A prospective validation study is now required to determine if this translates into improved patient outcomes.
Highlights
Open corpus callosotomy was first described by van Wagenen and Herren in 1940 to prevent “the disordered wave of nerve impulses...spreading widely to other parts of the neopallial portion of the brain” (VAN WAGENEN and HERREN, 1940)
The residual interhemispheric connectivity was at the anterior-most aspect of the genu of the corpus callosum and related to cortical vasculature restricting the non-dominant frontal lobe trajectory from targeting the rostrum
We show that computer-assisted planning was able to successfully plan feasible trajectories for laser interstitial thermal therapy (LITT) corpus callosotomy with a significantly improved risk score and minimum distance from vasculature
Summary
Open corpus callosotomy was first described by van Wagenen and Herren in 1940 to prevent “the disordered wave of nerve impulses...spreading widely to other parts of the neopallial portion of the brain” (VAN WAGENEN and HERREN, 1940). Disconnection of interhemispheric connectivity through the anterior two-thirds of the corpus callosum is a highly effective palliative procedure that is most commonly undertaken for drop attacks and tonic, atonic or tonic-clonic seizures as part of Lennox-Gastaut syndrome. Anterior two-thirds corpus callosotomy is an effective palliative neurosurgical procedure for drugrefractory epilepsy that is most commonly used to treat drop-attacks. Objective: To undertake a simulation-based feasibility study of computer-assisted corpus callostomy planning in comparison with expert manual plans in the same patients. Computer-assisted planning was performed using the EpiNavTM platform and compared to manually planned trajectories from two independent blinded experts. Results: Computer-assisted planning resulted in significantly improved trajectory safety metrics (risk score and minimum distance to vasculature) compared to blinded external expert manual plans. Conclusion: Computer-assisted planning successfully generates multi-trajectory plans capable of LITT anterior two-thirds corpus callosotomy. A prospective validation study is required to determine if this translates into improved patient outcomes
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