Magnetic resonance imaging-guided laser interstitial thermal therapy (MRIgLITT) has been proven safe and effective for the treatment of focal epilepsy of different etiologies. It has also been used to disconnect brain tissue in more extensive or diffuse epilepsy, such as corpus callosotomy and hemispherotomy. In this study, we report a case of temporo-parieto-occipital disconnection (TPO) surgery performed using MRIgLITT assisted by a robotic arm for refractory epilepsy of the posterior quadrant. A highly realistic cadaver simulation was performed before the actual surgery. The patient was a 14-year-old boy whose seizures began at the age of eight. The epilepsy was a result of a left perinatal ischemic event that caused a porencephalic cyst, and despite receiving multiple antiepileptic drugs, the patient continued to experience daily seizures which led to the recommendation of surgery. A Wada test lateralized language in the right hemisphere. Motor and sensory function was confirmed in the left hemisphere through MRI functional studies and NexStim®. The left MRIgLITT TPO disconnection was achieved using five laser fibers. The patient followed an excellent postoperative course and was seizure-free, with no additional neurological deficits 24 months after the surgery.
Keywords: MRIgLITT; TPO; laser ablation; pediatric epilepsy surgery; posterior quadrant disconnection; temporo-parieto-occipital disconnection.
Copyright © 2024 Elsevier Inc. All rights reserved.