Abstract
Abstract INTRODUCTION Tuberous Sclerosis (TSC) is a well-known cause of Medically Refractory Epilepsy (MRE). It is well documented that early surgical management can improve patient outcomes. Stereoencephalography-directed Magnetic Resonance guided Laser Interstitial Thermal Therapy (SEEG-directed MRgLITT) is an emerging minimally invasive technique that appears aptly suited for the surgical management of this condition. Our aims are to present our experiences with patients who had undergone prior SEEG-directed MRgLITT to identify and treat cortical tubers responsible for clinical seizures and to perform an in-depth analysis of volumetric and thermal dynamic factors that may be related to seizure outcomes. METHODS We studied all pediatric patients with MRE due to TSC who underwent SEEG-directed MRgLITT, investigating seizure outcomes in relationship to thermal dynamic and volumetric factors of MRgLITT when applied to cortical tubers. RESULTS About 8 cortical tubers from 3 pediatric patients were analyzed. About 2 out of 3 patients had Engel I outcomes at last follow-up. Median follow-up was 15 mo. Average A/T (ablation volume/tuber volume) ratio for Engel I outcomes was 1.28 (variance, 0.16) and 0.84 (variance < 0.01) for all other outcomes (P = .035). When assessing thermal dynamic properties of cortical tuber tissue, there was a moderate positive correlation when comparing ablation energy to ablation volume (R2 = 0.65). When the calcified tuber is excluded from regression analysis, the correlation is stronger (R2 = 0.77). Thus, the calculated volume to ablate 1 cm3 of cortical tuber tissue is 1263.6 J (calcified tuber) or 1089.5 J (noncalcified tuber). CONCLUSION SEEG-directed MRgLITT is a safe and effective technique in the management of pediatric patients with MRE due to TSC. It appears that the A/T ratio is a useful indicator in predicting seizure outcomes.
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