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Case Report
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| Robot-assisted stereotactic laser ablation of residual epileptogenic focus in the setting of chronic low back pain | ||||||
| Alvin Y. Chan1, Jack J. Lin2, Lilit Mnatsakanyan2, Mona Sazgar2, Indranil Sen-Gupta2, Frank Hsu1, Sumeet Vadera1 | ||||||
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1Department of Neurological Surgery, University of California, Irvine.
2Department of Neurology, Epilepsy Division, University of California, Irvine. | ||||||
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| Chan AY, Lin JJ, Mnatsakanyan L, Sazgar M, Sen-Gupta I, Hsu F, Vadera S. Robot-assisted stereotactic laser ablation of residual epileptogenic focus in the setting of chronic low back pain. Int J Case Rep Images 2016;7(8):554–558. |
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Abstract
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Introduction:
Stereotactic laser-induced thermal therapy (LITT) is a minimally invasive procedure used to ablate a variety of intracranial pathology including tumors, epileptogenic foci and radiation necrosis. Potential benefits of LITT over open resection include avoiding a large craniotomy and pain associated with this.
Case Report: We present a 58-year-old male who originally presented 15 years prior with new-onset seizures due to a low-grade astrocytoma in the left lateral temporal lobe. He underwent focal tumor resection at that time but continued to have seizures. The patient had a history of degenerative disease in the lumbar spine and had already undergone several surgeries in the past including a failed fusion. He presented to our center where video-electroencephalogram (vEEG) localized the ictal onset zone to the left mesial temporal lobe adjacent to the resection cavity. He was offered craniotomy and LITT therapy, and he elected to undergo LITT. Robotic assistance was utilized and bone fiducials were implanted for precise registration and implantation. A laser cannula was placed in the appropriate location and the ictal onset zone was ablated with MR-thermometry. The patient required no additional pain medications after surgery and has been seizure free since surgery. Conclusion: Our study demonstrates LITT can be beneficial over open craniotomy with regards to postoperative pain control in patients with severe chronic pain. Further, this case demonstrates the importance of considering tumors and epileptogenic foci as distinct and separate entities. Therefore, we advocate for evaluation and resection of ictal onset zones during initial tumor resection. | |
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Keywords:
Chronic pain, Laser-induced thermal therapy (LITT), Lesionectomy, ROSA robot
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Author Contributions
Alvin Y. Chan – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published Jack J. Lin – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published Lilit Mnatsakanyan – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published Mona Sazgar – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published Indranil Sen-Gupta – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published Frank Hsu – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published Sumeet Vadera – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published |
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Guarantor of submission
The corresponding author is the guarantor of submission. |
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Source of support
None |
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Conflict of interest
Authors declare no conflict of interest. |
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Copyright
© 2016 Alvin Y. Chan et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information. |
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