Outcomes of resective epilepsy surgery after focal stereotactic MR-guided laser interstitial thermal therapy for pediatric focal epilepsy: a case series.

Objective: MR-guided laser interstitial thermal therapy (MRgLITT) has emerged as a minimally invasive alternative to open resective epilepsy surgery for the ablation of seizure foci. This technique has become attractive to patients, caregivers, and epilepsy teams because it enables ablation of the seizure focus while avoiding craniotomy-specific complications of epilepsy surgery. For some indications, evidence suggests that MRgLITT is less effective than open surgery for achieving seizure control. However, open surgery after MRgLITT may be technically challenging or associated with higher complication rates due to the scar tissue generated by MRgLITT. Therefore, the authors investigated the indications and outcomes of open surgery after MRgLITT in a series of 7 pediatric epilepsy patients.

Methods: Patients who underwent MRgLITT surgery followed by resective surgery for an epilepsy focus between 2019 and 2024 at UPMC Children's Hospital of Pittsburgh were included in a retrospective analysis. Patients with less than 1 year of follow-up were excluded. Demographic, clinical, and procedural characteristics were collected for each patient, including seizure focus, baseline seizure burden and semiology, age at surgery, operative time, complications, and seizure outcomes.

Results: MRgLITT was successful in initially reducing seizure burden in 6 of 7 patients; however, return of seizure-like activity or aura phenomenon was the indication for open resection at an average of 23.29 months post-MRgLITT. Three patients required a second resective surgery due to persistent seizures. One year following the last open resection, 5 (71.4%) patients had attained International League Against Epilepsy class 1. Additionally, 4 of 7 patients had a significant reduction in antiseizure medications. Minimal complications were observed for both MRgLITT and open resective surgery in this case series.

Conclusions: In this case series, open resection after MRgLITT was observed to be a safe and effective method of surgical treatment of patients with refractory epilepsy after preliminary MRgLITT.