Is Edema a Matter of Concern After Laser Ablation of Epileptogenic Focus?
Publication/Presentation Date
5-1-2018
Abstract
BACKGROUND: A stereotactically placed laser fiber can deliver thermal energy to an epileptogenic focus in the brain. This procedure is done under intraoperative (thermography) magnetic resonance imaging (MRI) guidance. Thermoablation can lead to edema in the surrounding area and can cause a secondary insult. In this report of 3 cases, we have quantified the edema produced after laser ablation by sequential MRI in the immediate postoperative period.
CASE DESCRIPTIONS: Three patients with intractable epilepsy underwent a detailed neurologic and neuroradiologic workup to localize the site of epileptogenic foci. Two of the patients had mesial temporal lobe sclerosis, and the other patient had hypothalamic hamartoma. A laser fiber was placed stereotactically in the epileptogenic zone, and MRI-guided thermoablation was done. Postoperatively, T1-weighted and fluid-attenuated inversion recovery (FLAIR)-based volumetric MRI sequences were performed on postoperative days 1, 3, and 5 to quantify the edema. I-Plan software was used for volumetric analysis. Targeted volumes were 0.22, 4.2, and 3.5 mL, and lesions were 0.3, 6.5, and 6 mL, respectively. FLAIR hyperintensity was 2.3, 11.8, and 8.4 mL on the first postoperative day and 1.5, 12.6, and 6.3 mL on postoperative day 8. All patients remained seizure-free during the postoperative period. No complications were observed.
CONCLUSIONS: Laser ablation of epileptic focus is safe. FLAIR hyperintensity in the postoperative period is 3-5 times the targeted volume. However, no significant increase occurs during the first 8 days, and thus steroids can be stopped within 5 days of surgery.
Volume
113
First Page
366
Last Page
372
ISSN
1878-8769
Published In/Presented At
Tandon, V., Lang, M., Chandra, P. S., Sharan, A., Garg, A., & Tripathi, M. (2018). Is Edema a Matter of Concern After Laser Ablation of Epileptogenic Focus?. World neurosurgery, 113, 366–372.e3. https://doi.org/10.1016/j.wneu.2018.01.201
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
29425986
Department(s)
Administration and Leadership
Document Type
Article