Advancements in epilepsy surgery at Gaslini Children’s Hospital 2018-2021

The principal aim of the candidate’s course was to advance in the skills of research in the complex and evolving context of therapeutic strategies for medical refractory epilepsy in pediatric age. As a neurosurgeon graduate and consultant, part of a neurosurgical department, the candidate work consisted in two principal field of clinical practice-derived research: surgical treatment of hemispheric epilepsy in young infants and MRI- guided interstitial laser thermotherapy (MRg-LiTT) for refractory epilepsy of different origin. Hemispheric surgery is a subject of great interest as it represents an effective option for severe forms of epilepsy with high neurological morbidity, linked to developmental delay and that could be life-threatening, especially in very young infants. Studies focusing on first infancy are rare and more data are needed in literature. The second topic represents an important innovation in the Giannina’s Gaslini neurosurgical treatment offer. MRg-LiTT is a novel approach for the cure of refractory epilepsy, especially linked to hypothalamic hamartomas, with a significant shift in benefit-risk ratio, giving the opportunity to lower the high neurological morbidity linked to more traditional open-surgery approaches. The technique consists in the stereotactic introduction of a laser diode fiber inside a cerebral epileptogenic region (e.g. hypothalamic hamartomas, tuberous sclerosis, cavernomas, seizure onset zones), that is ablated by the high temperature delivered at the tip of the catheter, protecting the important surrounding structures using a near real-time MRI thermography technology.