title: Magnetic Resonance Thermometry-Guided Stereotactic Laser Ablation of Cavernous Malformations in Drug-Resistant Epilepsy: Imaging and Clinical Results.
abstract: Surgery is indicated for cerebral cavernous malformations (CCM) that cause medically refractory epilepsy. Real-time magnetic resonance thermography (MRT)-guided stereotactic laser ablation (SLA) is a minimally invasive approach to treating focal brain lesions. SLA of CCM has not previously been described.
  
  
  
  To describe MRT-guided SLA, a novel approach to treating CCM-related epilepsy, with respect to feasibility, safety, imaging, and seizure control in 5 consecutive patients.
  
  
  
  Five patients with medically refractory epilepsy undergoing standard presurgical evaluation were found to have corresponding lesions fulfilling imaging characteristics of CCM and were prospectively enrolled. Each underwent stereotactic placement of a saline-cooled cannula containing an optical fiber to deliver 980-nm diode laser energy via twist drill craniostomy. MR anatomic imaging was used to evaluate targeting prior to ablation. MR imaging provided evaluation of targeting and near real-time feedback regarding extent of tissue thermocoagulation. Patients maintained seizure diaries, and remote imaging (6-21 months post-ablation) was obtained in all patients.
  
  
  
  Imaging revealed no evidence of acute hemorrhage following fiber placement within presumed CCM. MRT during treatment and immediate post-procedure imaging confirmed desired extent of ablation. We identified no adverse events or neurological deficits. Four of 5 (80%) patients achieved freedom from disabling seizures after SLA alone (Engel class 1 outcome), with follow-up ranging 12-28 months. Reimaging of all subjects (6-21 months) indicated lesion diminution with surrounding liquefactive necrosis, consistent with the surgical goal of extended lesionotomy.
  
  
  
  Minimally invasive MRT-guided SLA of epileptogenic CCM is a potentially safe and effective alternative to open resection. Additional experience and longer follow-up are needed.
authors.affiliation: Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: D Jay
authors.initials: DJ
authors.lastname: McCracken
authors.affiliation: Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia.|Department of Neurology, Emory University School of Medicine, Atlanta, Georgia.|Interventional MRI Program, Emory University Hospital, Atlanta, Georgia.
authors.forename: Jon T
authors.initials: JT
authors.lastname: Willie
authors.affiliation: Visualase, Inc., Houston, Texas.
authors.forename: Brad A
authors.initials: BA
authors.lastname: Fernald
authors.affiliation: Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Amit M
authors.initials: AM
authors.lastname: Saindane
authors.affiliation: Department of Neurology, University of Washington School of Medicine, Seattle, Washington.
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Drane
authors.affiliation: Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Barrow
authors.affiliation: Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia.|Department of Neurology, Emory University School of Medicine, Atlanta, Georgia.|Interventional MRI Program, Emory University Hospital, Atlanta, Georgia.|Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Gross
mesh_terms: D004827:Epilepsy / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D053685:Laser Therapy; D008279:Magnetic Resonance Imaging; D009682:Magnetic Resonance Spectroscopy; D016896:Treatment Outcome
keywords: Epilepsy; cavernous malformation; laser therapy; magnetic resonance imaging; minimally invasive surgical procedures; stereotactic techniques; thermometry