Laser ablation is effective for temporal lobe epilepsy with and without mesial temporal sclerosis if hippocampal seizure onsets are localized by stereoelectroencephalography

Abstract

We report similar rates of seizure freedom following SLAH in patients with MTS and SEEG-confirmed, non-MTS MTLE. Consistent with early literature, these rates are slightly lower than typically observed with surgical resection (60%-80%). However, SLAH is less invasive than open surgery, with shorter hospital stays and recovery, and severe procedural complications are rare. SLAH may be a reasonable first-line surgical option for patients with both MTS and SEEG confirmed, non-MTS MTLE.

Laser ablation for mesial temporal lobe epilepsy: Surgical and cognitive outcomes with and without mesial temporal sclerosis

“…These outcomes are roughly comparable to traditional amygdalo‐hippocampectomies and anterior temporal lobe resections, and are better than previously published MRIgLITT case series . Compared to traditional anterior temporal resections, where Engel I surgical outcomes at 2 years of follow‐up is obtained for about 67% of patients, the Engel I surgical outcome obtained after MRIgLITT has been viewed as inferior by about 10%‐20% . Further, analyzing patients with a diagnosis of MTS and the necessity of SEEG investigations for seizure‐onset zone identification revealed no statistically significant differences between the percentages of patients with Engel class I surgical outcomes (Figure B).…”

“…6,[8][9][10] Compared to traditional anterior temporal resections, where Engel I surgical outcomes at 2 years of follow-up is obtained for about 67% of patients, 43 the Engel I surgical outcome obtained after MRIgLITT has been viewed as inferior by about 10%-20%. 3,5,44,45 Further, analyzing patients with a diagnosis of MTS and the necessity of SEEG investigations for seizure-onset zone identification revealed no statistically significant differences between the percentages of patients with Engel class I surgical outcomes ( Figure 3B). This provides a first answer to Kang and Sperling's question 16 whether patients without evidence of mesial temporal sclerosis on MRI scans are good candidates for MRIgLITT.…”

Multicenter validation of automated trajectories for selective laser amygdalohippocampectomy

“…Single‐center case series report that LITT for MTLE is a safe and effective first‐line alternative to open temporal lobe surgery in cases of mesial temporal sclerosis or where mesial temporal seizure onset has been proven by SEEG . A recent meta‐analysis of LITT for MTLE has suggested an overall seizure freedom rate of 50% at 12‐36 months, rising to 62% when considering “lesional” cases only .…”

“…Single-center case series report that LITT for MTLE is a safe and effective first-line alternative to open temporal lobe surgery in cases of mesial temporal sclerosis or where mesial temporal seizure onset has been proven by SEEG. [3][4][5][6]12,24,25 A recent meta-analysis of LITT for MTLE has suggested an overall seizure freedom rate of 50% at 12-36 months, rising to 62% when considering "lesional" cases only. 26 Despite the promise of LITT as an alternative first-line therapy, a single case series has reported an overall complication rate of 22.4%, 27 including catheter misplacement, intracranial hemorrhage, device malfunction, hemiparesis, cranial neuropathy, and visual field deficits.…”

“…Laser interstitial thermal therapy (LITT) is a novel minimally invasive technique for performing highly selective ablations within the brain and spine . Contemporary series of LITT for mesial temporal lobe epilepsy (MTLE) have reported seizure‐freedom rates comparable to those for open neurosurgical resection, with some centers now offering this as first‐line treatment . The highly selective nature of the thermal ablation has also been suggested to result in less neuropsychological deficit as a consequence of limiting damage to collateral brain structures .…”