title: Stereotactic laser ablation of epileptogenic periventricular nodular heterotopia.
abstract: Periventricular nodular heterotopia (PVNH) is a neuronal migrational disorder often associated with pharmacoresistant epilepsy (PRE). Resective surgery for PVNH is limited by its deep location, and the overlying eloquent cortex or white matter. Stereotactic MR guided laser interstitial thermal therapy (MRgLITT) has recently become available for controlled focal ablation, enabling us to target these lesions. We here demonstrate the novel application and techniques for the use of MRgLITT in the management of PVNH epilepsy. Comprehensive presurgical evaluation, including intracranial EEG monitoring in two patients revealed the PVNH to be crucially involved in their PRE. We used MRgLITT to maximally ablate the PVNH in both cases. In the first case, seizure medication adjustment coupled with PVNH ablation, and in the second, PVNH ablation in addition to temporal lobectomy rendered the patient seizure free. A transient visual deficit occurred following ablation in the second patient. MRgLITT is a promising minimally invasive technique for ablation of epileptogenic PVNH, a disease not generally viewed as surgically treatable epilepsy. We also show here the feasibility of applying this technique through multiple trajectories and to create lesions of complex shapes. The broad applicability and long term efficacy of MRgLITT need to be elaborated further.
authors: Vivian L. Smith Department of Neurosurgery, University of Texas Health Science Center at Houston, Medical School, Houston, TX, USA.
authors: Yoshua
authors: Y
authors: Esquenazi
authors: Department of Neurology, University of Texas Health Science Center at Houston, Medical School, Houston, TX, USA.
authors: Giridhar P
authors: GP
authors: Kalamangalam
authors: Department of Neurology, University of Texas Health Science Center at Houston, Medical School, Houston, TX, USA.
authors: Jeremy D
authors: JD
authors: Slater
authors: Department of Neurology, University of Texas Health Science Center at Houston, Medical School, Houston, TX, USA.
authors: Robert C
authors: RC
authors: Knowlton
authors: Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, Medical School, Houston, TX, USA.
authors: Elliott
authors: E
authors: Friedman
authors: Vivian L. Smith Department of Neurosurgery, University of Texas Health Science Center at Houston, Medical School, Houston, TX, USA.
authors: Saint-Aaron
authors: SA
authors: Morris
authors: Visualase Inc., Houston, TX, USA.
authors: Anil
authors: A
authors: Shetty
authors: Visualase Inc., Houston, TX, USA.
authors: Ashok
authors: A
authors: Gowda
authors: Vivian L. Smith Department of Neurosurgery, University of Texas Health Science Center at Houston, Medical School, Houston, TX, USA; Mischer Neuroscience Institute, Memorial Hermann Hospital, Texas Medical Center, USA. Electronic address: nitin.tandon@uth.tmc.edu.
authors: Nitin
authors: N
authors: Tandon
mesh_terms: D000328:Adult; D004569:Electroencephalography; D004827:Epilepsy / Q000209:etiology* / Q000601:surgery*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D053685:Laser Therapy / Q000379:methods*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D054091:Periventricular Nodular Heterotopia / Q000150:complications*; D016896:Treatment Outcome
keywords: Cortical dysplasia periventricular nodular heterotopia; Epilepsy surgery; MRI guided laser ablation; Medically refractory epilepsy; Thermal therapy