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Epilepsia. 2019 Jun;60(6):1171-1183. doi: 10.1111/epi.15565. Epub 2019 May 21.

Effects of surgical targeting in laser interstitial thermal therapy for mesial temporal lobe epilepsy: A multicenter study of 234 patients.

Author information

1
Department of Neurological Surgery, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, Philadelphia, Pennsylvania.
2
Department of Neurological Surgery, Jackson Memorial Hospital, University of Miami, Miami, Florida.
3
Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, Tennessee.
4
Department of Neurology, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, Philadelphia, Pennsylvania.
5
Department of Neurological Surgery, Harborview Medical Center, University of Washington, Seattle, Washington.
6
Department of Neurology, Harborview Medical Center, University of Washington, Seattle, Washington.
7
Department of Neurological Surgery, Neurological Institute of New York, Columbia University Medical Center, New York, New York.
8
Department of Neurological Surgery, Baylor College of Medicine, Houston, Texas.
9
Department of Neurological Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina.
10
Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, North Carolina.
11
Department of Neurological Surgery, Zucker School of Medicine at Hofstra Northwell, Hempstead, New York.
12
Department of Neurological Surgery, Stanford Neuroscience Health Center, Stanford, California.
13
Department of Neurological Surgery, Vanderbilt University, Nashville, Tennessee.
14
Department of Neurological Surgery, University of Louisville, Louisville, Kentucky.
15
Department of Neurological Surgery, University of South Florida Health South Tampa Center, Tampa, Florida.
16
Department of Neurological Surgery, Virginia Commonwealth University, Richmond, Virginia.
17
Department of Neurological Surgery, Henry Ford Health System, Detroit, Michigan.

Abstract

OBJECTIVE:

Laser interstitial thermal therapy (LITT) for mesial temporal lobe epilepsy (mTLE) has reported seizure freedom rates between 36% and 78% with at least 1 year of follow-up. Unfortunately, the lack of robust methods capable of incorporating the inherent variability of patient anatomy, the variability of the ablated volumes, and clinical outcomes have limited three-dimensional quantitative analysis of surgical targeting and its impact on seizure outcomes. We therefore aimed to leverage a novel image-based methodology for normalizing surgical therapies across a large multicenter cohort to quantify the effects of surgical targeting on seizure outcomes in LITT for mTLE.

METHODS:

This multicenter, retrospective cohort study included 234 patients from 11 centers who underwent LITT for mTLE. To investigate therapy location, all ablation cavities were manually traced on postoperative magnetic resonance imaging (MRI), which were subsequently nonlinearly normalized to a common atlas space. The association of clinical variables and ablation location to seizure outcome was calculated using multivariate regression and Bayesian models, respectively.

RESULTS:

Ablations including more anterior, medial, and inferior temporal lobe structures, which involved greater amygdalar volume, were more likely to be associated with Engel class I outcomes. At both 1 and 2 years after LITT, 58.0% achieved Engel I outcomes. A history of bilateral tonic-clonic seizures decreased chances of Engel I outcome. Radiographic hippocampal sclerosis was not associated with seizure outcome.

SIGNIFICANCE:

LITT is a viable treatment for mTLE in patients who have been properly evaluated at a comprehensive epilepsy center. Consideration of surgical factors is imperative to the complete assessment of LITT. Based on our model, ablations must prioritize the amygdala and also include the hippocampal head, parahippocampal gyrus, and rhinal cortices to maximize chances of seizure freedom. Extending the ablation posteriorly has diminishing returns. Further work is necessary to refine this analysis and define the minimal zone of ablation necessary for seizure control.

KEYWORDS:

MRI ; ablation; amygdalohippocampectomy; stereotactic; surgery

PMID:
31112302
PMCID:
PMC6551254
[Available on 2020-06-01]
DOI:
10.1111/epi.15565

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