Outcomes of Magnetic Resonance-Guided Laser Interstitial Thermal Therapy for Epileptogenic Cavernous Malformations: A Multicenter Study.
Publication/Presentation Date
9-9-2026
Abstract
BACKGROUND AND OBJECTIVES: Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) is an emerging minimally invasive alternative for epileptogenic cerebral cavernous malformations (CCMs). Available evidence is limited to small, single-center series. This multicenter study aimed to evaluate the efficacy and safety of MRgLITT for epileptogenic CCMs (eCCMs) in heterogeneous real-world practice and identify factors that may guide patient selection and technique.
METHODS: In this multicenter retrospective cohort study with no overlap to previous series, 23 adult patients with eCCMs underwent MRgLITT at 6 institutions between 2015 and 2023. Seizure outcomes were analyzed for 19 patients with ≥ 1-year follow-up. Patient characteristics and adverse events were reported for all patients.
RESULTS: Of 23 patients, 60.9% (14/23) were men, and median age was 50.5 (range 18.0-70.4 years). The median duration from epilepsy diagnosis to treatment was 10 years (range 1-42 years). Lesions were targeted in the left hemisphere in 60.9% (14/23) and to the temporal lobe in 65.2% (15/23). Engel class I seizure freedom was achieved in 57.8% (11/19) at 1 year, all of whom remained seizure free at last follow-up (median 2.2 years, range 1.0-8.6 years). Engel class I-II (favorable) outcomes were achieved in 68.4% (13/19) at 1 year and 73.7% (14/19) at last follow-up. Shorter duration of epilepsy before treatment was associated with seizure freedom (median 8.4 vs 25.5 years, P = .026). Fully concordant presurgical workup was associated with favorable outcome (odds ratio not estimable, 95% CI [0.81, ∞], P = .045) at last follow-up. Perioperative hemorrhage was detected in 3 patients (13.0%), all asymptomatic, with no subsequent hemorrhage during follow-up. Three patients (13.0%) experienced transient neurological deficits. One (4.3%) had a persistent deficit at last follow-up.
CONCLUSION: MRgLITT is a promising minimally invasive option for carefully selected patients with eCCMs. Shorter epilepsy duration and concordant presurgical evaluation may predict favorable outcome.
ISSN
2332-4260
Published In/Presented At
Shlobin, N. A., Jimenez, A. E., Yevudza, W. E., Jr, Agopyan-Miu, A., Bhole, S., Willie, J. T., Couture, D. E., Laxton, A. W., Hines, K., Wu, C., Chen, H. I., Lisko, T., McGovern, R. A., Connolly, E. S., McKhann, G. M., 2nd, & Youngerman, B. E. (2026). Outcomes of Magnetic Resonance-Guided Laser Interstitial Thermal Therapy for Epileptogenic Cavernous Malformations: A Multicenter Study. Operative neurosurgery (Hagerstown, Md.), 10.1227/ons.0000000000002190. Advance online publication. https://doi.org/10.1227/ons.0000000000002190
PubMedID
42714382
Department(s)
Department of Surgery
Document Type
Article