Equal but Different? MRI-Guided Stereotactic Laser Amygdalohippocampectomy and Traditional Temporal Lobe Surgery

Jobst, Barbara C.

doi:10.5698/1535-7511-15.5.250

Cited by 5 publications

(1 citation statement)

References 14 publications

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“…With regard to epilepsy surgery, LiTT promises to be particularly feasible for the following indications (sorted in descending order according to number of publications): mesial temporal lobe epilepsy (mTLE), e.g. selective amygdalohippocampectomy (SAH) [5,8,[57][58][59][60][61][62][63][64][65][66][67][68][69], hypothalamic hamartoma (HH) [37,46,[70][71][72][73][74], complex and deep focal cortical dysplasias (FCD), including double cortex [54,[75][76][77], nodular periventricual heterotopias (NPVH) [78,79], tuberous sclerosis (TS) and subependymal giant cell astrocytoma [80], cavernoma/cavernous malformation (including surrounding hemosiderin ring) [81].…”

Section: Indicationsmentioning

confidence: 99%

Laser interstitial thermotherapy (LiTT) in epilepsy surgery

Hoppe

Witt

Helmstaedter

et al. 2017

Seizure

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Besides other innovative stereotactic procedures (radiofrequency thermocoagulation, focused ultrasound, gamma knife) laser interstitial thermotherapy (LiTT) provides minimally invasive destruction of pathological soft tissues which could be especially relevant for epilepsy surgeries involving adult and pediatric patients. Unlike standard resections, no craniotomy is required; just a tiny borehole trepanation is sufficient. Damage to cortical areas when accessing deep lesions can be minimized or completely avoided, and treating epileptogenic foci near eloquent or even vital brain areas becomes possible. Here, we briefly describe the history and rationale of laser neurosurgery as well as the technical key features of the two currently available systems for magnetic resonance-guided LiTT (Visualase, NeuroBlate; CE marks pending for both). We also discuss the published clinical experience with LiTT in the field of epilepsy surgery (approximately 200 cases) with regard to complications, LiTT-induced, long-term brain structural alterations, seizure outcome, preliminary neuropsychological findings and first estimates of treatment costs. Overall, the seizure outcome appears to be slightly worse than for resective surgery. Due to insufficient research methods (e.g. non-established measures, lack of a control condition), the expected neuropsychological superiority over resective surgery has not been unambiguously demonstrated thus far. Also, the cost-benefit ratio requires further critical evaluation. Clinical, multi-center and adequately controlled outcome studies of high quality should also accompany the imminent introduction of LiTT into the field of epilepsy surgery and therewith permit critical scientific evaluation and rational, individual, clinical decisions.

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Section: Indicationsmentioning

confidence: 99%

Laser interstitial thermotherapy (LiTT) in epilepsy surgery

Hoppe

Witt

Helmstaedter

et al. 2017

Seizure

View full text Add to dashboard Cite

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Non-resective Epilepsy Surgery

Zentner¹

2020

Surgical Treatment of Epilepsies

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Stereotaktische Laserthermokoagulation in der Epilepsiechirurgie

et al. 2017

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In common with other stereotactic procedures, stereotactic laser thermocoagulation (SLT) promises gentle destruction of pathological tissue, which might become especially relevant for epilepsy surgery in the future. Compared to standard resection, no large craniotomy is necessary, cortical damage during access to deep-seated lesions can be avoided and interventions close to eloquent brain areas become possible. We describe the history and rationale of laser neurosurgery as well as the two available SLT systems (Visualase® and NeuroBlate®; CE marks pending). Both systems are coupled with magnetic resonance imaging (MRI) and MR thermometry, thereby increasing patient safety. We report the published clinical experiences with SLT in epilepsy surgery (altogether approximately 200 cases) with respect to complications, brain structural alterations, seizure outcome, neuropsychological findings and treatment costs. The rate of seizure-free patients seems to be slightly lower than for resection surgery. Due to the inadequate quality of studies, the neuropsychological superiority of SLT has not yet been unambiguously demonstrated.

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Equal but Different? MRI-Guided Stereotactic Laser Amygdalohippocampectomy and Traditional Temporal Lobe Surgery

Cited by 5 publications

References 14 publications

Laser interstitial thermotherapy (LiTT) in epilepsy surgery

Laser interstitial thermotherapy (LiTT) in epilepsy surgery

Non-resective Epilepsy Surgery

Stereotaktische Laserthermokoagulation in der Epilepsiechirurgie

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