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Author Notes:

Corresponding author at: Department of Clinical and Experimental Epilepsy, Queen Square Institute of Neurology, University College London, 33 Queen Square, London, WC1N 3BG, UK v.vakharia@ucl.ac.uk

VNV, RES and SBV were involved with study conception, technical expertise, acquisition and processing of the data.

YB, JTW, ADM, CW and AS were involved with manual trajectory planning and/or providing clinical expertise.

SO and JSD provided study supervision and critical revision of the manuscript. All authors reviewed the manuscript prior to submission.

The authors have no conflicts of interest to declare.

Subjects:

Research Funding:

NIHR UCLH/UCL Biomedical Research Centre, senior investigator schemes and Wellcome Trust (WT106882) / Wellcome/EPSRC (203145Z/16/Z).

Keywords:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Neuroimaging
  • Neurosciences & Neurology
  • Computer-assisted planning
  • Laser interstitial thermal therapy
  • Corpus Callosotomy
  • EPILEPSY
  • TRAJECTORIES
  • STIMULATION
  • ELECTRODES
  • OUTCOMES

Computer-assisted planning for minimally invasive anterior two-thirds laser corpus callosotomy: A feasibility study with probabilistic tractography validation

Tools:

Journal Title:

NeuroImage: Clinical

Volume:

Volume 25

Publisher:

, Pages 102174-102174

Type of Work:

Article | Final Publisher PDF

Abstract:

Background: Anterior two-thirds corpus callosotomy is an effective palliative neurosurgical procedure for drug-refractory epilepsy that is most commonly used to treat drop-attacks. Laser interstitial thermal therapy is a novel stereotactic ablative technique that has been utilised as a minimally invasive alternative to resective and disconnective open neurosurgery. Case series have reported success in performing laser anterior two-thirds corpus callosotomy. Computer-assisted planning algorithms may help to automate and optimise multi-trajectory planning for this procedure. Objective: To undertake a simulation-based feasibility study of computer-assisted corpus callostomy planning in comparison with expert manual plans in the same patients. Methods: Ten patients were selected from a prospectively maintained database. Patients had previously undergone diffusion-weighted imaging and digital subtraction angiography as part of routine SEEG care. Computer-assisted planning was performed using the EpiNav™ platform and compared to manually planned trajectories from two independent blinded experts. Estimated ablation cavities were used in conjunction with probabilistic tractography to simulate the expected extent of interhemispheric disconnection. Results: Computer-assisted planning resulted in significantly improved trajectory safety metrics (risk score and minimum distance to vasculature) compared to blinded external expert manual plans. Probabilistic tractography revealed residual interhemispheric connectivity in 1/10 cases following computer-assisted planning compared to 4/10 and 2/10 cases with manual planning. Conclusion: Computer-assisted planning successfully generates multi-trajectory plans capable of LITT anterior two-thirds corpus callosotomy. Computer-assisted planning may provide a means of standardising trajectory planning and serves as a potential new tool for optimising trajectories. A prospective validation study is now required to determine if this translates into improved patient outcomes.

Copyright information:

© 2020 The Authors

This is an Open Access work distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/).
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