MR-guided laser interstitial thermal therapy for drug-resistant lesional epilepsy:a single-center experience

Background To describe and report the efficacy and safety of MR-guided laser interstitial thermal therapy(MRgLITT)in the treatment of drug-resistant epilepsy.Methods A retrospective review of all MRgLITT procedures in our hospital was performed.All procedures were performed using a surgical laser ablation system.Demographic and outcome data were compiled and analyzed.Results A total of 19 patients underwent MRgLITT procedures from June 2021 to November 2021.The average age at surgery was 18.1 years(3-61.4 years).The average length of hospitalization post-surgery was 4.95 days(4-7 days).Surgical substrates included 8 patients with hypothalamic hamartomas,5 with medial temporal lobe epilepsy,3 with deep focal cortical dysplasia,1 with tuberous sclerosis,1 with a cavernous malformation,and 1 with Lennox-Gastaut syndrome who underwent anterior corpus callosotomy.Complications occurred in three patients.After an average follow-up of 1 year,6 patients were seizure-free(Engel I,31.6%),1 had significant seizure control(Engel II,5.3%),7 had seizure control(Engel III,36.8%),and 5 had no improvement in their seizures(Engel IV,26.3%).Fisher’s exact tests did not reveal statistical significance for the association between Engel class outcome and epileptic disease.Conclusion This study confirmed that MRgLITT,as a method for treating drug-resistant epilepsy,is minimally invasive,safe,and efficient and that it can reduce the incidence of surgery-related complications.

Relationships between hemorrhage, angioarchitectural factors and collagen of arteriovenous malformations

Objective While associations between the angioarchitecture of arteriovenous malformations （AVMs） in the brain and pathological features have been described, here we investigated the relationship between the angioarchitecture, the pathological features of the vessel wall, and hemorrhagic events. Methods The study was conducted on 43 patients： 16 with ruptured AVM （rAVM）, 15 with non-ruptured AVM （nrAVM）, 6 with craniocerebral trauma （control） and 6 with epilepsy （control）. The diagnosis of AVM was confirmed by preoperative digital subtraction angiography. Tissues were stained with hematoxylin and eosin and Masson＇s trichrome （for collagen fibers） to evaluate the vessel wall structure and endothelial integrity. The content and distribution of collagen types I and III in the vessel wall were assessed by immunohistochemical staining. Results In the nrAVM group, the nidus had more draining veins than the rAVM group （P 〈0.05）. Severely damaged endothelial cells, significantly fewer smooth muscle cells in the media, and hyperplasic type-I and -III collagen fibers were found in the rAVM group. The content of collagen types I and III in rAVMs was higher than that in the nrAVM （P 〈0.05） and control groups （P 〈0.01）. Conclusion There is an association between angioarchitectural features such as the number of draining veins and the pathological structure of the AVM wall. These abnormalities may contribute to AVM rupture.

Postoperative incidence of seizure and cerebral infarction in pediatric patients with epileptic type moyamoya disease:a meta-analysis of single rate

Background:Surgery is a conventional mature treatment for moyamoya disease(MMD).However,whether surgery is also an effective therapy for epileptic type MMD has seldom been investigated systematically.The study aims to summarize the pooled postoperative incidence of seizure and cerebral infarction in pediatric patients with epileptic type moyamoya disease.Method:The study was a systematic review and critical appraisal with a meta-analysis of cohort studies,both prospective and retrospective.Studies were identified by a computerized search of PubMed,Embase,Web of Science,Wanfang,and CNKI databases.In a literature search,a total of 7 cohort studies were identified.The I2statistic was used to quantify heterogeneity.A fixed-effect model was used to synthesize the results.The linear regression test of funnel plot asymmetry was used to estimate the potential publication bias.Results:The pooled estimated postoperative incidence of seizure in pediatric patients with epileptic type moyamoya disease was 23.44%.The pooled estimated postoperative incidence of cerebral infarction in pediatric patients with epileptic type moyamoya disease was 9.12%.Low substantial heterogeneity and potential publication bias were present.Conclusions:Evidence from this study suggests that the postoperative incidence of seizure and cerebral infarction is relatively low.Surgery is an effective and secure therapy for pediatric patients with epileptic type moyamoya disease.