247. Laser Interstitial Thermal Therapy (LITT) for the Treatment of Pediatric Epilepsy: A Single Institution Experience

Authors: Esther Cleveland Beeson Dupepe, MSPH, MD; Alexander Scott, BS; Jarod Roland, MD; Matthew Smyth, MD (St Louis, MO)

Introduction:

Laser interstitial thermal therapy (LITT) is a less invasive alternative to open surgery.  Here we report a single institution’s experience with this treatment modality for pediatric patients with medically refractory epilepsy.

Methods:

We retrospectively reviewed clinical outcome variables in 30 patients (age 5yo to 21.4 yo) treated for medically refractory epilepsy with LITT.    

Results: 

Visualase (Medtronic Inc) was used in 17 patients and Neuroblate (Monteris Medical Corp.) for 13 patients.  ROSA was used to plan trajectories in 26 cases and Stealth Navigation and the Starfix Platform were each used for 2 patients. Underlying pathology included focal cortical dysplasia (5), tumor (5), cavernomas (2), mesial temporal epilepsy (3), Tuberous Sclerosis (2), periventricular heterotopia (1) and Rasmussen’s encephalitis (1). Two patients without any underlying pathology had seizure foci determined by invasive monitoring and 9 patients underwent palliative corpus callosotomy.

The average OR time was 6 hr 25 min.  17 patients were admitted to the PICU and 13 to the floor postoperatively.  Average hospital length of stay was 2.16 days. Complications included prolonged case duration for fiber repositioning (2) and an MRI coil malfunction (1). One patient developed an SMA syndrome (resolved) and another developed homonymous hemianopsia (expected). There were no hemorrhagic or infectious complications. 

Average overall follow up was 18.7 months.  Excluding patients treated for palliation, 17 (81%) were Engel class 1 or 2 at 30 day follow up and 11 (52%) patients remained Engel class 1 or 2 at last known follow up (range 6-55 months, average 24.9 months). For patients undergoing palliative CC, 7 (78%) had a clinically relevant reduction in seizure burden, were able to decrease their medications or reported other improvements in their quality of life. 

Conclusion: 

LITT is well tolerated and a reasonable treatment option for pediatric patients with medically refractory epilepsy.