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