Outcomes of Magnetic Resonance-Guided Laser Interstitial Thermal Therapy for Epileptogenic Cavernous Malformations: A Multicenter Study.

BACKGROUND AND

OBJECTIVES

Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) is an emerging minimally invasive alternative for epileptogenic cerebral cavernous malformations (CCMs). Available evidence is limited to small, single-center series. This multicenter study aimed to evaluate the efficacy and safety of MRgLITT for epileptogenic CCMs (eCCMs) in heterogeneous real-world practice and identify factors that may guide patient selection and technique.

METHODS

In this multicenter retrospective cohort study with no overlap to previous series, 23 adult patients with eCCMs underwent MRgLITT at 6 institutions between 2015 and 2023. Seizure outcomes were analyzed for 19 patients with ≥ 1-year follow-up. Patient characteristics and adverse events were reported for all patients.

RESULTS

Of 23 patients, 60.9% (14/23) were men, and median age was 50.5 (range 18.0-70.4 years). The median duration from epilepsy diagnosis to treatment was 10 years (range 1-42 years). Lesions were targeted in the left hemisphere in 60.9% (14/23) and to the temporal lobe in 65.2% (15/23). Engel class I seizure freedom was achieved in 57.8% (11/19) at 1 year, all of whom remained seizure free at last follow-up (median 2.2 years, range 1.0-8.6 years). Engel class I-II (favorable) outcomes were achieved in 68.4% (13/19) at 1 year and 73.7% (14/19) at last follow-up. Shorter duration of epilepsy before treatment was associated with seizure freedom (median 8.4 vs 25.5 years, P = .026). Fully concordant presurgical workup was associated with favorable outcome (odds ratio not estimable, 95% CI [0.81, ∞], P = .045) at last follow-up. Perioperative hemorrhage was detected in 3 patients (13.0%), all asymptomatic, with no subsequent hemorrhage during follow-up. Three patients (13.0%) experienced transient neurological deficits. One (4.3%) had a persistent deficit at last follow-up.

CONCLUSION

MRgLITT is a promising minimally invasive option for carefully selected patients with eCCMs. Shorter epilepsy duration and concordant presurgical evaluation may predict favorable outcome.