Subcentimeter epilepsy surgery targets by resting state functional magnetic resonance imaging can improve outcomes in hypothalamic hamartoma

Authors

Varina L. Boerwinkle, Division of Pediatric Neurology, Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, Arizona.Follow
Stephen T. Foldes, Neuroscience Research, Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, Arizona.Follow
Salvatore J. Torrisi, Section on the Neurobiology of Fear and Anxiety, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland.
Hamy Temkit, Department of Research, Phoenix Children's Hospital, Phoenix, Arizona.
William D. Gaillard, Department of Neurology, Children's National Medical Center, Washington, District of Columbia.
John F. Kerrigan, Division of Pediatric Neurology, Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, Arizona.
Virendra R. Desai, Department of Neurosurgery, Houston Methodist Hospital, Houston Methodist Neurological Institute, Houston, Texas.
Jeffrey S. Raskin, Department of Pediatric Neurosurgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.
Aditya Vedantam, Department of Pediatric Neurosurgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.
Randa Jarrar, Division of Pediatric Neurology, Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, Arizona.
Korwyn Williams, Division of Pediatric Neurology, Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, Arizona.
Sandi Lam, Department of Pediatric Neurosurgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.
Manish Ranjan, Division of Pediatric Neurosurgery, Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, Arizona.
Janna S. Broderson, Division of Pediatric Neurology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.
David Adelson, Division of Pediatric Neurology, Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, Arizona.Follow
Angus A. Wilfong, Division of Pediatric Neurology, Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, Arizona.
Daniel J. Curry, Department of Pediatric Neurosurgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.

Document Type

Article

Abstract

OBJECTIVE: The purpose of this study is to investigate the outcomes of epilepsy surgery targeting the subcentimeter-sized resting state functional magnetic resonance imaging (rs-fMRI) epileptogenic onset zone (EZ) in hypothalamic hamartoma (HH). METHODS: Fifty-one children with HH-related intractable epilepsy received anatomical MRI-guided stereotactic laser ablation (SLA) procedures. Fifteen of these children were control subjects (CS) not guided by rs-fMRI. Thirty-six had been preoperatively guided by rs-fMRI (RS) to determine EZs, which were subsequently targeted by SLA. The primary outcome measure for the study was a predetermined goal of 30% reduction in seizure frequency and improvement in class I Engel outcomes 1 year postoperatively. Quantitative and qualitative volumetric analyses of total HH and ablated tissue were also assessed. RESULTS: In the RS group, the EZ target within the HH was ablated with high accuracy (>87.5% of target ablated in 83% of subjects). There was no difference between the groups in percentage of ablated hamartoma volume (P = 0.137). Overall seizure reduction was higher in the rs-fMRI group: 85% RS versus 49% CS (P = 0.0006, adjusted). The Engel Epilepsy Surgery Outcome Scale demonstrated significant differences in those with freedom from disabling seizures (class I), 92% RS versus 47% CS, a 45% improvement (P = 0.001). Compared to prior studies, there was improvement in class I outcomes (92% vs 76%-81%). No postoperative morbidity or mortality occurred. SIGNIFICANCE: For the first time, surgical SLA targeting of subcentimeter-sized EZs, located by rs-fMRI, guided surgery for intractable epilepsy. Our outcomes demonstrated the highest seizure freedom rate without surgical complications and are a significant improvement over prior reports. The approach improved freedom from seizures by 45% compared to conventional ablation, regardless of hamartoma size or anatomical classification. This technique showed the same or reduced morbidity (0%) compared to recent non-rs-fMRI-guided SLA studies with as high as 20% permanent significant morbidity.

Keywords

epilepsy surgery, functional connectivity, hypothalamic hamartoma, intractable epilepsy, resting state functional MRI

Medical Subject Headings

Adolescent; Child; Child, Preschool; Drug Resistant Epilepsy (diagnostic imaging, etiology, surgery); Female; Hamartoma (complications, diagnostic imaging, surgery); Humans; Hypothalamic Diseases (complications, diagnostic imaging, surgery); Hypothalamic Neoplasms (complications, diagnostic imaging, surgery); Infant; Magnetic Resonance Imaging; Male; Neurosurgical Procedures (methods); Postoperative Complications (epidemiology); Reproducibility of Results; Treatment Outcome; Young Adult

Publication Date

12-1-2018

Publication Title

Epilepsia

E-ISSN

1528-1167

Volume

59

Issue

12

First Page

2284

Last Page

2295

PubMed ID

30374947

Digital Object Identifier (DOI)

10.1111/epi.14583

Recommended Citation

Boerwinkle, Varina L.; Foldes, Stephen T.; Torrisi, Salvatore J.; Temkit, Hamy; Gaillard, William D.; Kerrigan, John F.; Desai, Virendra R.; Raskin, Jeffrey S.; Vedantam, Aditya; Jarrar, Randa; Williams, Korwyn; Lam, Sandi; Ranjan, Manish; Broderson, Janna S.; Adelson, David; Wilfong, Angus A.; and Curry, Daniel J., "Subcentimeter epilepsy surgery targets by resting state functional magnetic resonance imaging can improve outcomes in hypothalamic hamartoma" (2018). Translational Neuroscience. 2216.
https://scholar.barrowneuro.org/neurobiology/2216