Dave Clarke, MD, Elizabeth Tyler-Kabara, MD, PhD, and Winson Ho, MD, of the Pediatric Neurosciences Program recently performed laser interstitial thermal therapy on a four-month-old infant. This is likely the youngest patient to undergo the procedure.
Although laser interstitial thermal therapy is increasingly utilized in the surgical treatment of epilepsy, it is seldom employed in individuals less than two years old. Placement and stabilization of the laser fibers rely on stereotactic navigation techniques that assume maturity of the patient’s skull configuration. However, laser interstitial therapy is a particularly intriguing option for individuals who may have multiple epileptogenic zones that could require multiple procedures over time, such as individuals with tuberous sclerosis complex (TSC).
The team adapted a Navigus biopsy skull mount and used electromagnetic navigation to position the laser fiber in an infant. The four-month-old child with TSC had experienced numerous clinical and electrographic seizures per day. Noninvasive testing (MRI, magnetoencephalography, scalp EEG, and SPECT) localized the seizure onset to a left frontal premotor cortical tuber, but several other tubers were present. The child underwent successful laser ablation of the epileptogenic tuber and remained seizure-free several months after surgery.
This new technique shows the feasibility of laser surgery for very young patients and should be particularly useful for individuals who might require multiple procedures.
Lee JJ, Clarke D, Hoverson E, Tyler-Kabara EC, Ho WS. MRI-guided laser interstitial thermal therapy using the Visualase system and Navigus frameless stereotaxy in an infant: technical case report. J Neurosurg Pediatr 2021;1-4.