Computer-assisted planning for minimally invasive anterior two-thirds laser corpus callosotomy: A feasibility study with probabilistic tractography validation
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 inv...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2020-01-01
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| Series: | NeuroImage: Clinical |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2213158220300139 |
| _version_ | 1811216228328407040 |
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| author | Vejay N. Vakharia Rachel E. Sparks Sjoerd B. Vos Yarema Bezchlibnyk Ashesh D. Mehta Jon T. Willie Chengyuan Wu Ashwini Sharan Sebastien Ourselin John S. Duncan |
| author_facet | Vejay N. Vakharia Rachel E. Sparks Sjoerd B. Vos Yarema Bezchlibnyk Ashesh D. Mehta Jon T. Willie Chengyuan Wu Ashwini Sharan Sebastien Ourselin John S. Duncan |
| author_sort | Vejay N. Vakharia |
| collection | DOAJ |
| description | 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. Keywords: Computer-assisted planning, Laser interstitial thermal therapy, Corpus Callosotomy |
| first_indexed | 2024-04-12T06:35:53Z |
| format | Article |
| id | doaj.art-6cd661364c5b47398ca16683ba685116 |
| institution | Directory Open Access Journal |
| issn | 2213-1582 |
| language | English |
| last_indexed | 2024-04-12T06:35:53Z |
| publishDate | 2020-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | NeuroImage: Clinical |
| spelling | doaj.art-6cd661364c5b47398ca16683ba6851162022-12-22T03:43:53ZengElsevierNeuroImage: Clinical2213-15822020-01-0125Computer-assisted planning for minimally invasive anterior two-thirds laser corpus callosotomy: A feasibility study with probabilistic tractography validationVejay N. Vakharia0Rachel E. Sparks1Sjoerd B. Vos2Yarema Bezchlibnyk3Ashesh D. Mehta4Jon T. Willie5Chengyuan Wu6Ashwini Sharan7Sebastien Ourselin8John S. Duncan9Department of Clinical and Experimental Epilepsy, University College London, London, UK; Chalfont Centre for Epilepsy and National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Corresponding author at: Department of Clinical and Experimental Epilepsy, Queen Square Institute of Neurology, University College London, 33 Queen Square, London, WC1N 3BG, UKSchool of Biomedical Engineering and Imaging Sciences, King's College London, London, United KingdomDepartment of Clinical and Experimental Epilepsy, University College London, London, UK; Centre for Medical Image Computing, University College London, London, United KingdomDepartment of Neurosurgery and Brain Repair, University of South Florida, Tampa, Florida, United StatesNorthwell Health Neuroscience Institute, New York, United StatesDepartment of Neurological Surgery, Emory University Hospital, Atlanta, Georgia, United StatesDivision of Epilepsy and Neuromodulation Neurosurgery, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, PhiladelphiaDivision of Epilepsy and Neuromodulation Neurosurgery, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, PhiladelphiaSchool of Biomedical Engineering and Imaging Sciences, King's College London, London, United KingdomDepartment of Clinical and Experimental Epilepsy, University College London, London, UK; Chalfont Centre for Epilepsy and National Hospital for Neurology and Neurosurgery, Queen Square, London, UKBackground: 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. Keywords: Computer-assisted planning, Laser interstitial thermal therapy, Corpus Callosotomyhttp://www.sciencedirect.com/science/article/pii/S2213158220300139 |
| spellingShingle | Vejay N. Vakharia Rachel E. Sparks Sjoerd B. Vos Yarema Bezchlibnyk Ashesh D. Mehta Jon T. Willie Chengyuan Wu Ashwini Sharan Sebastien Ourselin John S. Duncan Computer-assisted planning for minimally invasive anterior two-thirds laser corpus callosotomy: A feasibility study with probabilistic tractography validation NeuroImage: Clinical |
| title | Computer-assisted planning for minimally invasive anterior two-thirds laser corpus callosotomy: A feasibility study with probabilistic tractography validation |
| title_full | Computer-assisted planning for minimally invasive anterior two-thirds laser corpus callosotomy: A feasibility study with probabilistic tractography validation |
| title_fullStr | Computer-assisted planning for minimally invasive anterior two-thirds laser corpus callosotomy: A feasibility study with probabilistic tractography validation |
| title_full_unstemmed | Computer-assisted planning for minimally invasive anterior two-thirds laser corpus callosotomy: A feasibility study with probabilistic tractography validation |
| title_short | Computer-assisted planning for minimally invasive anterior two-thirds laser corpus callosotomy: A feasibility study with probabilistic tractography validation |
| title_sort | computer assisted planning for minimally invasive anterior two thirds laser corpus callosotomy a feasibility study with probabilistic tractography validation |
| url | http://www.sciencedirect.com/science/article/pii/S2213158220300139 |
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