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Neurosurgery. 2014 Jun;74(6):569-84; discussion 584-5. doi: 10.1227/NEU.0000000000000343.

Real-time magnetic resonance-guided stereotactic laser amygdalohippocampotomy for mesial temporal lobe epilepsy.

Author information

1
Departments of *Neurosurgery, ‡Neurology, §Pathology, and ¶Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia; ‖Interventional MRI Program, Emory University Hospital, Atlanta, Georgia; #Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia; **Department of Neurology, University of Washington School of Medicine, Seattle, Washington; ††Visualase, Inc., Houston, Texas.

Abstract

BACKGROUND:

Open surgery effectively treats mesial temporal lobe epilepsy, but carries the risk of neurocognitive deficits, which may be reduced with minimally invasive alternatives.

OBJECTIVE:

To describe technical and clinical outcomes of stereotactic laser amygdalohippocampotomy with real-time magnetic resonance thermal imaging guidance.

METHODS:

With patients under general anesthesia and using standard stereotactic methods, 13 adult patients with intractable mesial temporal lobe epilepsy (with and without mesial temporal sclerosis [MTS]) prospectively underwent insertion of a saline-cooled fiberoptic laser applicator in amygdalohippocampal structures from an occipital trajectory. Computer-controlled laser ablation was performed during continuous magnetic resonance thermal imaging followed by confirmatory contrast-enhanced anatomic imaging and volumetric reconstruction. Clinical outcomes were determined from seizure diaries.

RESULTS:

A mean 60% volume of the amygdalohippocampal complex was ablated in 13 patients (9 with MTS) undergoing 15 procedures. Median hospitalization was 1 day. With follow-up ranging from 5 to 26 months (median, 14 months), 77% (10/13) of patients achieved meaningful seizure reduction, of whom 54% (7/13) were free of disabling seizures. Of patients with preoperative MTS, 67% (6/9) achieved seizure freedom. All recurrences were observed before 6 months. Variances in ablation volume and length did not account for individual clinical outcomes. Although no complications of laser therapy itself were observed, 1 significant complication, a visual field defect, resulted from deviated insertion of a stereotactic aligning rod, which was corrected before ablation.

CONCLUSION:

Real-time magnetic resonance-guided stereotactic laser amygdalohippocampotomy is a technically novel, safe, and effective alternative to open surgery. Further evaluation with larger cohorts over time is warranted.

PMID:
24618797
PMCID:
PMC4151501
DOI:
10.1227/NEU.0000000000000343
[Indexed for MEDLINE]
Free PMC Article
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