MR-guided laser interstitial thermal therapy for pediatric drug-resistant lesional XXXX .

@entity1 @entity410 @entity302 @entity1141
OBJECTIVE: To report the feasibility, safety, and clinical outcomes of an exploratory study of MR-guided Laser Interstitial Thermal Therapy (MRgLITT) as a minimally invasive surgical procedure for the ablation of epileptogenic foci in @entity1 with drug-resistant, lesional @entity302 . METHODS: Retrospective chart review of all MRgLITT procedures at a single tertiary care center. All procedures were performed using a U.S. Food and Drug Administration (FDA)-cleared surgical laser ablation system (Visualase Thermal Therapy System). Predefined clinical and surgical variables were extracted from archived medical records. RESULTS: Seventeen @entity1 underwent 19 MRgLITT procedures from May 2011 to January 2014. Mean age at @entity410 onset was 7.1  years (range 0.1-14.8  years). Mean age at surgery was 15.3  years (range 5.9-20.6  years). Surgical substrates were mixed but mainly composed of focal cortical @entity1141 (n  =  11). Complications occurred in four @entity1 . Average length of hospitalization postsurgery was 1.56  days. Mean follow-up was 16.1  months (n  =  16; range 3.5-35.9  months). Engel class I outcome was achieved in seven @entity1 (7/17; 41%), Engel class II in one (1/17; 6%), Engel class III in three (3/17; 18%), and Engel class IV in six (6/17; 35%). Three @entity1 (3/8; 38%) with class I and II outcomes and five @entity1 (5/9; 56%) with class III and IV outcomes had at least one prior resection. Fisher's exact test was not statistically significant for the association between Engel class outcome and previous resection (p  =  0.64). SIGNIFICANCE: This study provides descriptive results regarding the use of MRgLITT in a mixed population of pediatric, lesional, drug-resistant @entity302 cases. The ability to classify case-specific outcomes and reduce technical complications is anticipated as experience develops. Further multicenter, prospective studies are required to delineate optimal candidates for MRgLITT, and larger cohorts are needed to more accurately define outcome and complication rates.
