• Saint-Aaron Morris, Matthew Rollo, Patrick Rollo, Jessica Johnson, Gerald A Grant, Elliott Friedman, Giridhar Kalamangalam, and Nitin Tandon.
• Vivian L. Smith Department of Neurosurgery, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Texas, USA.
• World Neurosurg. 2017 Aug 1; 104: 467-475.

ObjectiveLaser interstitial thermal therapy has become increasingly popular for targeting epileptic foci in a minimally invasive fashion. Despite its use in >1000 patients, the long-term effects of photothermal injury on brain physiology remain poorly understood.MethodsWe prospectively followed clinical and radiographic courses of 13 patients undergoing laser ablation for focal epilepsy by the senior author (N.T.). Only patients with nonenhancing lesions and patients who had a delayed postoperative magnetic resonance imaging (MRI) scan with gadolinium administration approximately 6 months after ablation were considered. Volumetric estimates of the amount of enhancement immediately after ablation and on the delayed MRI scan were made.ResultsMedian interval between surgery and delayed postoperative MRI scan was 6 months (range, 5-8 months). In 12 of 13 cases, persistent enhancement was seen, consistent with prolonged blood-brain barrier dysfunction. Enhancement, when present, was 9%-67% (mean 30%). There was no correlation between the time from surgery and the relative percentage of postoperative enhancement on MRI. The blood-brain barrier remained compromised to gadolinium contrast for up to 8 months after thermal therapy. There were no adverse events from surgical intervention; however, 1 patient developed delayed optic neuritis.ConclusionsProlonged incompetence of the blood-brain barrier produced by thermal ablation may provide a path for delivery of macromolecules into perilesional tissue, which could be exploited for therapeutic benefit, but rarely it may result in autoimmune central nervous system inflammatory conditions.Copyright © 2017 Elsevier Inc. All rights reserved.

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