Prolonged Blood-Brain Barrier Disruption Following Laser Interstitial Ablation in Epilepsy: A Case Series with a Case Report of Postablation Optic Neuritis

World Neurosurgery
Saint-Aaron MorrisNitin Tandon

Abstract

Laser interstitial thermal therapy has become increasingly popular for targeting epileptic foci in a minimally invasive fashion. Despite its use in >1000 patients, the long-term effects of photothermal injury on brain physiology remain poorly understood. We prospectively followed clinical and radiographic courses of 13 patients undergoing laser ablation for focal epilepsy by the senior author (N.T.). Only patients with nonenhancing lesions and patients who had a delayed postoperative magnetic resonance imaging (MRI) scan with gadolinium administration approximately 6 months after ablation were considered. Volumetric estimates of the amount of enhancement immediately after ablation and on the delayed MRI scan were made. Median interval between surgery and delayed postoperative MRI scan was 6 months (range, 5-8 months). In 12 of 13 cases, persistent enhancement was seen, consistent with prolonged blood-brain barrier dysfunction. Enhancement, when present, was 9%-67% (mean 30%). There was no correlation between the time from surgery and the relative percentage of postoperative enhancement on MRI. The blood-brain barrier remained compromised to gadolinium contrast for up to 8 months after thermal therapy. There were no adverse even...Continue Reading

References

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Citations

Dec 7, 2017·Epilepsia·Suganya KarunakaranNitin Tandon
Feb 28, 2020·Neurology·Cristian DonosNitin Tandon
Jul 17, 2020·International Journal of Hyperthermia : the Official Journal of European Society for Hyperthermic Oncology, North American Hyperthermia Group·Madison RemickTaylor J Abel
Jul 17, 2020·International Journal of Hyperthermia : the Official Journal of European Society for Hyperthermic Oncology, North American Hyperthermia Group·Ethan S SrinivasanPeter E Fecci
Jul 17, 2020·International Journal of Hyperthermia : the Official Journal of European Society for Hyperthermic Oncology, North American Hyperthermia Group·Joshua D FrensterDimitris G Placantonakis
Oct 31, 2020·Current Neurology and Neuroscience Reports·Hui Ming KhooFrançois Dubeau
May 8, 2021·Clinical Neurology and Neurosurgery·Alexandros G BrotisKonstantinos N Fountas
Oct 31, 2021·Journal of Neurology, Neurosurgery, and Psychiatry·David SatzerPeter Warnke

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