Impact of Previous Surgery on Success of Magnetic Resonance-guided Laser Interstitial Thermal Therapy (MRgLITT) to Treat Pediatric Epilepsy: An Institutional Experience.

BACKGROUND: There is an emerging role for minimally invasive magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) in the treatment of pediatric epilepsy refractory to medication. To date, predictors of MRgLITT success have not been established in a sizeable singular experience. Correspondingly, the aim of this study was to elucidate if previous surgical history predicts MRgLITT success in this setting. METHODS: A retrospective review was conducted of our MRgLITT procedures for pediatric (patient age <19 years) epilepsy from 2011 to 2020 with documented seizure outcomes at 1 and 2 years after procedure. Categorical and continuous data were compared using χ2 and Student's t test, respectively. RESULTS: A total of 41 patients satisfied all criteria with 16 (39%) female and 25 (61%) male patients. Following MRgLITT, seizure-freedom at 1-year was achieved in 15 (37%) patients. In the cohort, there were 14 (34%) patients who had undergone previous open surgery for epilepsy at mean age of 9.4 ± 5.5 years. Patients with a previous open surgery history were found to statistically experience longer length of hospitalization after MRgLITT (P = 0.04) with a statistically lower proportion of seizure-freedom at 1-year after MRgLITT (14% vs. 48%, P = 0.03). However, there was no difference in the rate of seizure-freedom at 2 years (29% vs. 41%, P = 0.44), as well as no difference in subsequent surgical interventions for seizure management between groups. CONCLUSIONS: Based on our institutional experience, patients with previous open surgery history may experience longer length of hospitalization after MRgLITT for pediatric epilepsy and lesser response in seizure-freedom within the first year but with non-inferior seizure freedom by the second year.

Prioritizing Pediatricians' Neurosurgical Education: Results From a National Survey of Primary Care Pediatricians.

Introduction. We surveyed nonretired American Academy of Pediatrics-member US pediatricians regarding common neurosurgical conditions, identifying specific areas of focus in education. Methods. Data were acquired via self-administered electronic questionnaire. Results. Of 505 total respondents, 56% reported neurology was not a required residency rotation, and 86% had diagnosed craniosynostosis, plagiocephaly, or macrocephaly. Craniosynostosis can mostly be diagnosed by physical examination alone, but almost 50% reported relying on skull X-rays. Fifty-four percent reported diagnosing ocular surface disease (OSD; with 15% to 40% not screening an infant despite well-established cutaneous markers). Seventy-four screened OSD in a patient with sacral dimple. Ninety-seven percent reported treating concussion, but nearly 25% did not manage these patients alone. Two out of 3 patients indicated head injury as most important for continuing education. Conclusion. Improved education for craniosynostosis, OSD, head injury, and concussion management are important for earlier diagnosis, management, and referral of some disorders, while decreasing resource utilization in others. These results should be used when considering pediatrician educational programs.