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Ann Neurol. 2018 Mar;83(3):575-587. doi: 10.1002/ana.25180. Epub 2018 Mar 3.

Stereotactic laser amygdalohippocampotomy for mesial temporal lobe epilepsy.

Author information

1
Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA.
2
Department of Neurology, Emory University School of Medicine, Atlanta, GA.
3
Medical Scientist Training Program, Emory University School of Medicine, Atlanta, GA.
4
Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA.
5
Department of Neurology, University of Washington School of Medicine, Seattle, WA.
6
Department of Pediatrics, Emory University School of Medicine, Atlanta, GA.

Abstract

OBJECTIVE:

To evaluate the outcomes 1 year and longer following stereotactic laser amygdalohippocampotomy for mesial temporal lobe epilepsy in a large series of patients treated over a 5-year period since introduction of this novel technique.

METHODS:

Surgical outcomes of a consecutive series of 58 patients with mesial temporal lobe epilepsy who underwent the surgery at our institution with at least 12 months of follow-up were retrospectively evaluated. A subgroup analysis was performed comparing patients with and without mesial temporal sclerosis.

RESULTS:

One year following stereotactic laser amygdalohippocampotomy, 53.4% (95% confidence interval [CI] = 40.8-65.7%) of all patients were free of disabling seizures (Engel I). Three of 9 patients became seizure-free following repeat ablation. Subgroup analysis showed that 60.5% (95% CI = 45.6-73.7%) of patients with mesial temporal sclerosis were free of disabling seizures as compared to 33.3% (95% CI = 15.0-58.5%) of patients without mesial temporal sclerosis. Quality of Life in Epilepsy-31 scores significantly improved at the group level, few procedure-related complications were observed, and verbal memory outcome was better than historical open resection data.

INTERPRETATION:

In an unselected consecutive series of patients, stereotactic laser amygdalohippocampotomy yielded seizure-free rates for patients with mesial temporal lobe epilepsy lower than, but comparable to, the outcomes typically associated with open temporal lobe surgery. Analogous to results from open surgery, patients without mesial temporal sclerosis fared less well. This novel procedure is an effective minimally invasive alternative to resective surgery. In the minority of patients not free of disabling seizures, laser ablation presents no barrier to additional open surgery. Ann Neurol 2018;83:575-587.

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