Outcomes of reoperation following failed laser ablation surgery for epilepsy in pediatric patients

There are significant challenges in the surgical management of pharmacoresistant epilepsy. Laser interstitial thermal therapy (LITT) has emerged as a less invasive alternative to resection. However, seizure persistence or recurrence following LITT is not uncommon, and there is currently a lack of guidance and consensus on the best way to manage seizure recurrence after LITT for different epilepsy etiologies in children, or for the use of LITT when open resection has left residual epileptogenic tissue. The objective of this study was to assess the outcomes of secondary epilepsy surgery after failed initial LITT.

The authors performed a retrospective chart review of patients who underwent secondary epilepsy surgery after failed LITT at Children's National Hospital.

A total of 36 patients were treated with LITT, and 4 were excluded due to the palliative purpose of LITT. Thirteen of 32 patients (40.6.%) achieved Engel I, 1 patient (3.1%) achieved Engel II, and 18 patients (56.2%) had poor outcomes (Engel III-IV). Of these 32 patients, 9 (28.1%) underwent reoperation after their first laser ablation surgery due to a recurrence of epilepsy. Seven patients had a second laser ablation, and 2 patients underwent open resection. Of these 9 patients, 3 (33.3%) had Engel I outcomes, and 6 (66.7%) had poor seizure outcomes (Engel III-IV). When considering only patients who had repeat LITT for reoperation, 2 of 7 (28.6%) of these patients achieved seizure freedom (Engel I). Of the 32 patients, short-term complications were transient oculomotor (n = 1, 3.1%) or trochlear (n = 1, 3.1%) nerve deficit, which entirely resolved within 6 months, and superior quadrantanopia (n = 1, 3.1%) after initial LITT.

Although LITT has shown promising results in treating pharmacoresistant epilepsy, the recurrence of seizures necessitates further evaluation and consideration of reoperation, which may result in seizure freedom. Repeat LITT is a low-risk option for secondary surgery after seizure recurrence.