title: Delayed Intraparenchymal and Intraventricular Hemorrhage Requiring Surgical Evacuation after MRI-Guided Laser Interstitial Thermal Therapy for Lesional Epilepsy.
abstract: Symptomatic intracranial hemorrhage is a rare complication of laser interstitial thermal therapy (LITT).
  
  
  
  To present a unique case of delayed symptomatic intracranial hemorrhage occurring after a LITT procedure for epilepsy in a high-volume center (68 LITT procedures for pediatric epilepsy have been performed).
  
  
  
  An 18-year-old male with epilepsy underwent LITT to an area of heterotopia near the right lateral ventricle. He did well initially and was discharged home on postoperative day 1 but returned on postoperative day 9 with headache and left hemiparesis. He was found to have intraparenchymal and intraventricular hemorrhage in the region of the LITT catheter tract.
  
  
  
  CT angiography on admission revealed a small vascular abnormality near the focus of hemorrhage suspicious for pseudoaneurysm, although conventional angiography was negative. The patient declined neurologically and underwent craniotomy and hemorrhage evacuation. He eventually convalesced and was discharged to inpatient rehabilitation with persistent left hemiparesis. He has been seizure free since the intervention but remains on antiepileptic drugs.
  
  
  
  Evidence from the literature suggests that the pathophysiology of symptomatic hemorrhage after LITT may be related to vascular injury and pseudoaneurysm formation from LITT catheter placement and/or thermal injury from the ablation itself.
authors.affiliation: Department of Neurosurgery, Houston Methodist Neurological Institute, Houston, TX, USA.
authors.forename: Sean M
authors.initials: SM
authors.lastname: Barber
authors.forename: Luke
authors.initials: L
authors.lastname: Tomycz
authors.forename: Timothy
authors.initials: T
authors.lastname: George
authors.forename: Dave F
authors.initials: DF
authors.lastname: Clarke
authors.forename: Mark
authors.initials: M
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging* / Q000209:etiology; D004827:Epilepsy / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D053685:Laser Therapy / Q000009:adverse effects*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D016343:Monitoring, Intraoperative / Q000379:methods; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000209:etiology; D013997:Time Factors
keywords: Epilepsy; Intracranial hemorrhage; Laser ablation; Pseudoaneurysm; Stereotactic techniques