A novel technique for frame-based MR-guided laser ablation in an infant

Area of Science:

• Neurology
• Neurosurgery
• Pediatric Epilepsy

Background:

• Hypothalamic hamartomata (HH) are associated with drug-resistant epilepsy, precocious puberty, and developmental delay.
• Gelastic seizures are a common manifestation of HH.
• MRI-guided laser interstitial thermal therapy (LiTT) is an effective treatment for HH, but requires accurate stereotactic implantation.

Purpose of the Study:

• To describe a novel technique for stereotactic frame fixation in infants for MRI-guided LiTT.
• To report the successful application of MRI-guided LiTT in a 5-month-old infant with HH and drug-resistant epilepsy.

Main Methods:

• A paste cast helmet was used for secure stereotactic frame placement in a 5-month-old infant.
• The frame allowed for accurate fiber implantation for MRI-guided LiTT.
• MRI thermography monitored tissue temperature during ablation.

Main Results:

• The paste cast helmet technique provided secure fixation for stereotactic frame placement in an infant.
• Successful MRI-guided LiTT was performed in a 5-month-old infant with HH and drug-resistant epilepsy.
• This demonstrates the feasibility of LiTT in very young children using this novel fixation method.

Conclusions:

• A paste cast helmet is a practical and safe method for stereotactic frame fixation in infants undergoing MRI-guided LiTT.
• This technique expands the potential application of LiTT to younger pediatric patients with HH.
• MRI-guided LiTT offers a viable treatment option for drug-resistant epilepsy caused by HH in infants.