Epilepsy Surgery in Young Children with Tuberous Sclerosis Complex: A Novel Hybrid Multimodal Surgical Approach

Vijay M. Ravindra; Patrick J. Karas; Tyler T. Lazaro; Rohini Coorg; Al Wala Awad; Ilana Patino; Emily E. McClernon; Dave Clarke; Laura Cairampoma Whitehead; Anne Anderson; Gloria Diaz-Medina; Kimberly Houck; Akshat Katyayan; Laura Masters; Audrey Nath; Michael Quach; James Riviello; Elaine S. Seto; Krystal Sully; Latanya Agurs; Sonali Sen; Maureen Handoko; Melissa Lopresti; Irfan Ali; Daniel J. Curry; Howard L. Weiner

doi:10.1227/neu.0000000000002214

Epilepsy Surgery in Young Children with Tuberous Sclerosis Complex: A Novel Hybrid Multimodal Surgical Approach

Vijay M. Ravindra, Patrick J. Karas, Tyler T. Lazaro, Rohini Coorg, Al Wala Awad, Ilana Patino, Emily E. McClernon, Dave Clarke, Laura Cairampoma Whitehead, Anne Anderson, Gloria Diaz-Medina, Kimberly Houck, Akshat Katyayan, Laura Masters, Audrey Nath, Michael Quach, James Riviello, Elaine S. Seto, Krystal Sully, Latanya AgursSonali Sen, Maureen Handoko, Melissa Lopresti, Irfan Ali, Daniel J. Curry, Howard L. Weiner

Research output: Contribution to journal › Article › peer-review

7 Scopus citations

Abstract

BACKGROUND: Surgery has become integral in treating children with tuberous sclerosis complex (TSC)-related drug-resistant epilepsy (DRE). OBJECTIVE: To describe outcomes of a multimodal diagnostic and therapeutic approach comprising invasive intracranial monitoring and surgical treatment and compare the complementary techniques of open resection and magnetic resonance-guided laser interstitial thermal therapy. METHODS: Clinical and radiographic data were prospectively collected for pediatric patients undergoing surgical evaluation for TSC-related DRE at our tertiary academic hospital. Seizure freedom, developmental improvement, and Engel class were compared. RESULTS: Thirty-eight patients (20 females) underwent treatment in January 2016 to April 2019. Thirty-five underwent phase II invasive monitoring with intracranial electrodes: 24 stereoencephalography, 9 craniotomy for grid/electrode placement, and 2 grids + stereoencephalography. With the multimodal approach, 33/38 patients (87%) achieved >50% seizure freedom of the targeted seizure type after initial treatment; 6/9 requiring secondary treatment and 2/2 requiring a third treatment achieved >50% freedom. The median Engel class was II at last follow-up (1.65 years), and 55% of patients were Engel class I/II. The mean age was lower for children undergoing open resection (2.4 vs 4.9 years, P =.04). Rates of >50% reduction in seizures (86% open resection vs 88% laser interstitial thermal therapy) and developmental improvement (86% open resection vs 83% magnetic resonance-guided laser interstitial thermal therapy) were similar. CONCLUSION: This hybrid approach of using both open surgical and minimally invasive techniques is safe and effective in treating DRE secondary to TSC. Clinical trials focused on treatment method with longer follow-up are needed to determine the optimal candidates for each approach and compare the treatment modalities more effectively.

Original language	English (US)
Pages (from-to)	398-406
Number of pages	9
Journal	Neurosurgery
Volume	92
Issue number	2
DOIs	https://doi.org/10.1227/neu.0000000000002214
State	Published - Feb 1 2023
Externally published	Yes

Keywords

Craniotomy
Electrocorticography
Laser ablation
Medically refractory epilepsy
Pediatric epilepsy
Stereoelectroencephalography
Tuberous sclerosis

ASJC Scopus subject areas

Clinical Neurology
Surgery

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10.1227/neu.0000000000002214

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Ravindra, V. M., Karas, P. J., Lazaro, T. T., Coorg, R., Awad, A. W., Patino, I., McClernon, E. E., Clarke, D., Cairampoma Whitehead, L., Anderson, A., Diaz-Medina, G., Houck, K., Katyayan, A., Masters, L., Nath, A., Quach, M., Riviello, J., Seto, E. S., Sully, K., ... Weiner, H. L. (2023). Epilepsy Surgery in Young Children with Tuberous Sclerosis Complex: A Novel Hybrid Multimodal Surgical Approach. Neurosurgery, 92(2), 398-406. https://doi.org/10.1227/neu.0000000000002214

Ravindra, VM, Karas, PJ, Lazaro, TT, Coorg, R, Awad, AW, Patino, I, McClernon, EE, Clarke, D, Cairampoma Whitehead, L, Anderson, A, Diaz-Medina, G, Houck, K, Katyayan, A, Masters, L, Nath, A, Quach, M, Riviello, J, Seto, ES, Sully, K, Agurs, L, Sen, S, Handoko, M, Lopresti, M, Ali, I, Curry, DJ & Weiner, HL 2023, 'Epilepsy Surgery in Young Children with Tuberous Sclerosis Complex: A Novel Hybrid Multimodal Surgical Approach', Neurosurgery, vol. 92, no. 2, pp. 398-406. https://doi.org/10.1227/neu.0000000000002214

@article{d1508cbcd0dc4789b157d2ce2367d6de,

title = "Epilepsy Surgery in Young Children with Tuberous Sclerosis Complex: A Novel Hybrid Multimodal Surgical Approach",

abstract = "BACKGROUND: Surgery has become integral in treating children with tuberous sclerosis complex (TSC)-related drug-resistant epilepsy (DRE). OBJECTIVE: To describe outcomes of a multimodal diagnostic and therapeutic approach comprising invasive intracranial monitoring and surgical treatment and compare the complementary techniques of open resection and magnetic resonance-guided laser interstitial thermal therapy. METHODS: Clinical and radiographic data were prospectively collected for pediatric patients undergoing surgical evaluation for TSC-related DRE at our tertiary academic hospital. Seizure freedom, developmental improvement, and Engel class were compared. RESULTS: Thirty-eight patients (20 females) underwent treatment in January 2016 to April 2019. Thirty-five underwent phase II invasive monitoring with intracranial electrodes: 24 stereoencephalography, 9 craniotomy for grid/electrode placement, and 2 grids + stereoencephalography. With the multimodal approach, 33/38 patients (87%) achieved >50% seizure freedom of the targeted seizure type after initial treatment; 6/9 requiring secondary treatment and 2/2 requiring a third treatment achieved >50% freedom. The median Engel class was II at last follow-up (1.65 years), and 55% of patients were Engel class I/II. The mean age was lower for children undergoing open resection (2.4 vs 4.9 years, P =.04). Rates of >50% reduction in seizures (86% open resection vs 88% laser interstitial thermal therapy) and developmental improvement (86% open resection vs 83% magnetic resonance-guided laser interstitial thermal therapy) were similar. CONCLUSION: This hybrid approach of using both open surgical and minimally invasive techniques is safe and effective in treating DRE secondary to TSC. Clinical trials focused on treatment method with longer follow-up are needed to determine the optimal candidates for each approach and compare the treatment modalities more effectively.",

keywords = "Craniotomy, Electrocorticography, Laser ablation, Medically refractory epilepsy, Pediatric epilepsy, Stereoelectroencephalography, Tuberous sclerosis",

author = "Ravindra, {Vijay M.} and Karas, {Patrick J.} and Lazaro, {Tyler T.} and Rohini Coorg and Awad, {Al Wala} and Ilana Patino and McClernon, {Emily E.} and Dave Clarke and {Cairampoma Whitehead}, Laura and Anne Anderson and Gloria Diaz-Medina and Kimberly Houck and Akshat Katyayan and Laura Masters and Audrey Nath and Michael Quach and James Riviello and Seto, {Elaine S.} and Krystal Sully and Latanya Agurs and Sonali Sen and Maureen Handoko and Melissa Lopresti and Irfan Ali and Curry, {Daniel J.} and Weiner, {Howard L.}",

year = "2023",

month = feb,

day = "1",

doi = "10.1227/neu.0000000000002214",

language = "English (US)",

volume = "92",

pages = "398--406",

journal = "Neurosurgery",

issn = "0148-396X",

publisher = "Lippincott Williams and Wilkins",

number = "2",

}

TY - JOUR

T1 - Epilepsy Surgery in Young Children with Tuberous Sclerosis Complex

T2 - A Novel Hybrid Multimodal Surgical Approach

AU - Ravindra, Vijay M.

AU - Karas, Patrick J.

AU - Lazaro, Tyler T.

AU - Coorg, Rohini

AU - Awad, Al Wala

AU - Patino, Ilana

AU - McClernon, Emily E.

AU - Clarke, Dave

AU - Cairampoma Whitehead, Laura

AU - Anderson, Anne

AU - Diaz-Medina, Gloria

AU - Houck, Kimberly

AU - Katyayan, Akshat

AU - Masters, Laura

AU - Nath, Audrey

AU - Quach, Michael

AU - Riviello, James

AU - Seto, Elaine S.

AU - Sully, Krystal

AU - Agurs, Latanya

AU - Sen, Sonali

AU - Handoko, Maureen

AU - Lopresti, Melissa

AU - Ali, Irfan

AU - Curry, Daniel J.

AU - Weiner, Howard L.

PY - 2023/2/1

Y1 - 2023/2/1

N2 - BACKGROUND: Surgery has become integral in treating children with tuberous sclerosis complex (TSC)-related drug-resistant epilepsy (DRE). OBJECTIVE: To describe outcomes of a multimodal diagnostic and therapeutic approach comprising invasive intracranial monitoring and surgical treatment and compare the complementary techniques of open resection and magnetic resonance-guided laser interstitial thermal therapy. METHODS: Clinical and radiographic data were prospectively collected for pediatric patients undergoing surgical evaluation for TSC-related DRE at our tertiary academic hospital. Seizure freedom, developmental improvement, and Engel class were compared. RESULTS: Thirty-eight patients (20 females) underwent treatment in January 2016 to April 2019. Thirty-five underwent phase II invasive monitoring with intracranial electrodes: 24 stereoencephalography, 9 craniotomy for grid/electrode placement, and 2 grids + stereoencephalography. With the multimodal approach, 33/38 patients (87%) achieved >50% seizure freedom of the targeted seizure type after initial treatment; 6/9 requiring secondary treatment and 2/2 requiring a third treatment achieved >50% freedom. The median Engel class was II at last follow-up (1.65 years), and 55% of patients were Engel class I/II. The mean age was lower for children undergoing open resection (2.4 vs 4.9 years, P =.04). Rates of >50% reduction in seizures (86% open resection vs 88% laser interstitial thermal therapy) and developmental improvement (86% open resection vs 83% magnetic resonance-guided laser interstitial thermal therapy) were similar. CONCLUSION: This hybrid approach of using both open surgical and minimally invasive techniques is safe and effective in treating DRE secondary to TSC. Clinical trials focused on treatment method with longer follow-up are needed to determine the optimal candidates for each approach and compare the treatment modalities more effectively.

AB - BACKGROUND: Surgery has become integral in treating children with tuberous sclerosis complex (TSC)-related drug-resistant epilepsy (DRE). OBJECTIVE: To describe outcomes of a multimodal diagnostic and therapeutic approach comprising invasive intracranial monitoring and surgical treatment and compare the complementary techniques of open resection and magnetic resonance-guided laser interstitial thermal therapy. METHODS: Clinical and radiographic data were prospectively collected for pediatric patients undergoing surgical evaluation for TSC-related DRE at our tertiary academic hospital. Seizure freedom, developmental improvement, and Engel class were compared. RESULTS: Thirty-eight patients (20 females) underwent treatment in January 2016 to April 2019. Thirty-five underwent phase II invasive monitoring with intracranial electrodes: 24 stereoencephalography, 9 craniotomy for grid/electrode placement, and 2 grids + stereoencephalography. With the multimodal approach, 33/38 patients (87%) achieved >50% seizure freedom of the targeted seizure type after initial treatment; 6/9 requiring secondary treatment and 2/2 requiring a third treatment achieved >50% freedom. The median Engel class was II at last follow-up (1.65 years), and 55% of patients were Engel class I/II. The mean age was lower for children undergoing open resection (2.4 vs 4.9 years, P =.04). Rates of >50% reduction in seizures (86% open resection vs 88% laser interstitial thermal therapy) and developmental improvement (86% open resection vs 83% magnetic resonance-guided laser interstitial thermal therapy) were similar. CONCLUSION: This hybrid approach of using both open surgical and minimally invasive techniques is safe and effective in treating DRE secondary to TSC. Clinical trials focused on treatment method with longer follow-up are needed to determine the optimal candidates for each approach and compare the treatment modalities more effectively.

KW - Craniotomy

KW - Electrocorticography

KW - Laser ablation

KW - Medically refractory epilepsy

KW - Pediatric epilepsy

KW - Stereoelectroencephalography

KW - Tuberous sclerosis

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DO - 10.1227/neu.0000000000002214

M3 - Article

C2 - 36637274

AN - SCOPUS:85146364393

SN - 0148-396X

VL - 92

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JO - Neurosurgery

JF - Neurosurgery

IS - 2

ER -

Epilepsy Surgery in Young Children with Tuberous Sclerosis Complex: A Novel Hybrid Multimodal Surgical Approach

Abstract

Keywords

ASJC Scopus subject areas

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