• D Jay McCracken, Jon T Willie, Brad A Fernald, Amit M Saindane, Daniel L Drane, Daniel L Barrow, and Robert E Gross.
• ‡Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia; §Department of Neurology, Emory University School of Medicine, Atlanta, Georgia; ¶Interventional MRI Program, Emory University Hospital, Atlanta, Georgia; ‖Visualase, Inc., Houston, Texas; #Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia; **Department of Neurology, University of Washington School of Medicine, Seattle, Washington; ‡‡Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia.
• Neurosurgery. 2015 Sep 25.

BackgroundSurgery is indicated for cerebral cavernous malformations (CCMs) 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.ObjectiveTo 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.MethodsFive patients with medically refractory epilepsy undergoing standard presurgical evaluation were found to have corresponding lesions fulfilling imaging characteristics of CCM and were prospectively enrolled. Each underwent stereotactic placement of a saline-cooled cannula containing an optical fiber to deliver 980-nm diode laser energy via twist drill craniostomy. MR anatomic imaging was used to evaluate targeting before ablation. MR imaging provided evaluation of targeting and near real-time feedback regarding the extent of tissue thermocoagulation. Patients maintained seizure diaries, and remote imaging (6-21 months postablation) was obtained in all patients.ResultsImaging revealed no evidence of acute hemorrhage following fiber placement within presumed CCM. MRT during treatment and immediate postprocedure imaging confirmed the desired extent of ablation. We identified no adverse events or neurological deficits. Four of 5 (80%) patients achieved freedom from disabling seizures after SLA alone (Engel class 1 outcome), with follow-up ranging 12 to 28 months. Reimaging of all subjects (6-21 months) indicated lesion diminution with surrounding liquefactive necrosis, consistent with the surgical goal of extended lesionotomy.ConclusionMinimally invasive MRT-guided SLA of epileptogenic CCM is a potentially safe and effective alternative to open resection. Additional experience and longer follow-up are needed.AbbreviationsCCM, cerebral cavernous malformationsGRE, gradient recalled echoMRT, magnetic resonance thermographySLA, stereotactic laser ablation.

26 keywords...

hide…