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World Neurosurg. 2017 Aug;104:467-475. doi: 10.1016/j.wneu.2017.05.009. Epub 2017 May 11.

Prolonged Blood-Brain Barrier Disruption Following Laser Interstitial Ablation in Epilepsy: A Case Series with a Case Report of Postablation Optic Neuritis.

Author information

1
Vivian L. Smith Department of Neurosurgery, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Texas, USA.
2
Department of Neurosurgery, Stanford University Medical Center, Stanford, California, USA.
3
Department of Radiology, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Texas, USA.
4
Department of Neurology, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Texas, USA.
5
Vivian L. Smith Department of Neurosurgery, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Texas, USA. Electronic address: nitin.tandon@uth.tmc.edu.

Abstract

OBJECTIVE:

Laser interstitial thermal therapy has become increasingly popular for targeting epileptic foci in a minimally invasive fashion. Despite its use in >1000 patients, the long-term effects of photothermal injury on brain physiology remain poorly understood.

METHODS:

We prospectively followed clinical and radiographic courses of 13 patients undergoing laser ablation for focal epilepsy by the senior author (N.T.). Only patients with nonenhancing lesions and patients who had a delayed postoperative magnetic resonance imaging (MRI) scan with gadolinium administration approximately 6 months after ablation were considered. Volumetric estimates of the amount of enhancement immediately after ablation and on the delayed MRI scan were made.

RESULTS:

Median interval between surgery and delayed postoperative MRI scan was 6 months (range, 5-8 months). In 12 of 13 cases, persistent enhancement was seen, consistent with prolonged blood-brain barrier dysfunction. Enhancement, when present, was 9%-67% (mean 30%). There was no correlation between the time from surgery and the relative percentage of postoperative enhancement on MRI. The blood-brain barrier remained compromised to gadolinium contrast for up to 8 months after thermal therapy. There were no adverse events from surgical intervention; however, 1 patient developed delayed optic neuritis.

CONCLUSIONS:

Prolonged incompetence of the blood-brain barrier produced by thermal ablation may provide a path for delivery of macromolecules into perilesional tissue, which could be exploited for therapeutic benefit, but rarely it may result in autoimmune central nervous system inflammatory conditions.

KEYWORDS:

Blood-brain barrier; Epilepsy; Laser ablation; Laser interstitial therapy; Thermal therapy; Tumors

PMID:
28502693
DOI:
10.1016/j.wneu.2017.05.009
[Indexed for MEDLINE]

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