Tailored Hemispherotomy Using Tractography-Guided Laser Interstitial Thermal Therapy.

Area of Science:

• Neurosurgery
• Epilepsy Treatment
• Minimally Invasive Procedures

Background:

• Medically refractory hemispheric epilepsy presents significant challenges, with functional hemispherotomy being effective but carrying high complication risks.
• Laser interstitial thermal therapy (LITT) offers a percutaneous approach, but its application in hemispherotomy, guided by MRI, remains limited and underexplored.

Observation:

• This study presents the first two cases utilizing tractography-guided LITT for hemispherotomy in pediatric patients with medically refractory epilepsy.
• Both patients had epilepsy secondary to perinatal large vessel infarcts and underwent multitrajectory LITT targeting the pathological hemisphere.

Findings:

• Tractography-guided LITT hemispherotomy resulted in seizure freedom for both patients, with only minor, non-intervention-requiring intraventricular/subarachnoid hemorrhage.
• Patients experienced short hospital stays and recovery periods following the minimally invasive procedure.

Implications:

• Tractography-guided LITT hemispherotomy demonstrates potential as a safe and effective treatment for hemispheric epilepsy, particularly in cases with distorted anatomy due to perinatal stroke.
• This minimally invasive technique may offer a favorable alternative to open hemispherotomy, maximizing seizure freedom while minimizing surgical risks.