Magnetic Resonance–Guided Laser Interstitial Thermal Therapy for Mesial Temporal Epilepsy: A Case Series Analysis of Outcomes and Complications at 2-Year Follow-Up

Cajigas, Iahn; Kanner, Andrés M.; Ribot, Ramses; Casabella, Amanda M.; Mahavadi, Anil; Jermakowicz, Walter J.; Sur, Samir; Millán, Carlos Ortega; Saporta, A.; Lowe, Merredith R.; Velez‐Ruiz, Naymee; Rey, Gustavo; Ibrahim, George M.; Ivan, Michael E.; Jagid, Jonathan

doi:10.1016/j.wneu.2019.03.057

Cited by 22 publications

(16 citation statements)

References 27 publications

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“…We note that the selection criteria for our cohort were not particularly strict (see Section 3), consistent with typical clinical criteria applied for determining LITT candidacy. These results are comparable to historical cohorts of one-trajectory LITT experience Engel class 1a seizure outcomes between 53% and 61%, 5,8,10,36 although due to the small power of our clinical results, direct comparisons are not statistically rigorous, and we do not make any claims about the clinical superiority of two-trajectory LITT; rather, our clinical results demonstrate that this approach is feasible. Due to our short follow-up and small cohort, the ability to draw definitive clinical conclusions is limited.…”

Section: Quantitative Benefits Of a Two-laser Trajectorysupporting

confidence: 61%

Two‐trajectory laser amygdalohippocampotomy: Anatomic modeling and initial seizure outcomes

et al. 2021

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Objective: Laser interstitial thermal therapy (LITT) for mesial temporal lobe epilepsy (mTLE) is typically performed with one trajectory to target the medial temporal lobe (MTL). MTL structures such as piriform and entorhinal cortex are epileptogenic, but due to their relative geometry, they are difficult to target with one trajectory while simultaneously maintaining adequate ablation of the amygdala and hippocampus. We hypothesized that a two-trajectory approach could improve ablation of all relevant MTL structures. First, we created large-scale computer simulations to compare idealized one-vs two-trajectory approaches. A two-trajectory approach was then validated in an initial cohort of patients. Methods:We used magnetic resonance imaging (MRI) from the Human Connectome Project (HCP) to create subject-specific target structures consisting of hippocampus, amygdala, and piriform/entorhinal/perirhinal cortex. An algorithm searched for safe potential trajectories along the hippocampal axis (catheter one) and along the amygdala-piriform axis (catheter two) and compared this to a single trajectory optimized over all structures. The proportion of each structure ablated at various burn radii was evaluated. A cohort of 11 consecutive patients with mTLE received two-trajectory LITT; demographic, operative, and outcome data were collected. Results:The two-trajectory approach was superior to the one-trajectory approach at nearly all burn radii for all hippocampal subfields and amygdala nuclei (p < .05). Two-laser trajectories achieved full ablation of MTL cortical structures at physiologically realistic burn radii, whereas one-laser trajectories could not. Five patients with at least 1 year of follow-up (mean = 21.8 months) experienced Engel class I outcomes; 6 patients with less than 1 year of follow-up (mean = 6.6 months) are on track for Engel class I outcomes.

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Section: Quantitative Benefits Of a Two-laser Trajectorysupporting

confidence: 61%

Two‐trajectory laser amygdalohippocampotomy: Anatomic modeling and initial seizure outcomes

et al. 2021

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“…From the 11 studies reporting LITT outcomes, two were prospective ( 51 , 52 ) and nine were retrospective (see Table 5 ). Overall, 520 patients were followed up, ranging between a mean of 12 months ( 13 , 53 – 56 ) and 43 months ( 57 ). Engel 1 outcomes for the studies ranged between 44% ( 14 ) and 67.4% ( 58 ).…”

Section: Resultsmentioning

confidence: 99%

Resective, Ablative and Radiosurgical Interventions for Drug Resistant Mesial Temporal Lobe Epilepsy: A Systematic Review and Meta-Analysis of Outcomes

et al. 2021

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Objectives: One-third of individuals with focal epilepsy do not achieve seizure freedom despite best medical therapy. Mesial temporal lobe epilepsy (MTLE) is the most common form of drug resistant focal epilepsy. Surgery may lead to long-term seizure remission if the epileptogenic zone can be defined and safely removed or disconnected. We compare published outcomes following open surgical techniques, radiosurgery (SRS), laser interstitial thermal therapy (LITT) and radiofrequency ablation (RF-TC).Methods: PRISMA systematic review was performed through structured searches of PubMed, Embase and Cochrane databases. Inclusion criteria encompassed studies of MTLE reporting seizure-free outcomes in ≥10 patients with ≥12 months follow-up. Due to variability in open surgical approaches, only comparative studies were included to minimize the risk of bias. Random effects meta-analysis was performed to calculate effects sizes and a pooled estimate of the probability of seizure freedom per person-year. A mixed effects linear regression model was performed to compare effect sizes between interventions.Results: From 1,801 screened articles, 41 articles were included in the quantitative analysis. Open surgery included anterior temporal lobe resection as well as transcortical and trans-sylvian selective amygdalohippocampectomy. The pooled seizure-free rate per person-year was 0.72 (95% CI 0.66–0.79) with trans-sylvian selective amygdalohippocampectomy, 0.59 (95% CI 0.53–0.65) with LITT, 0.70 (95% CI 0.64–0.77) with anterior temporal lobe resection, 0.60 (95% CI 0.49–0.73) with transcortical selective amygdalohippocampectomy, 0.38 (95% CI 0.14–1.00) with RF-TC and 0.50 (95% CI 0.34–0.73) with SRS. Follow up duration and study sizes were limited with LITT and RF-TC. A mixed-effects linear regression model suggests significant differences between interventions, with LITT, ATLR and SAH demonstrating the largest effects estimates and RF-TC the lowest.Conclusions: Overall, novel “minimally invasive” approaches are still comparatively less efficacious than open surgery. LITT shows promising seizure effectiveness, however follow-up durations are shorter for minimally invasive approaches so the durability of the outcomes cannot yet be assessed. Secondary outcome measures such as Neurological complications, neuropsychological outcome and interventional morbidity are poorly reported but are important considerations when deciding on first-line treatments.

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“…The details of the surgical procedure have been described in prior publications. [5][6][7] Intraoperative placement of the LiTT catheter was performed either using a frame-based approach or with the use of the ROSA ONE robot (Zimmer Biomet). Briefly, for the frame-based approach, a Cosman-Roberts-Wells stereotactic frame was placed, and a thin-cut computed tomographic view was obtained and merged with the preoperative MRI to obtain frame-based coordinates.…”

Section: Surgical Proceduresmentioning

confidence: 99%

Long‐term seizure and psychiatric outcomes following laser ablation of mesial temporal structures

et al. 2022

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Objective: Postsurgical seizure outcome following laser interstitial thermal therapy (LiTT) for the management of drug-resistant mesial temporal lobe epilepsy (MTLE) has been limited to 2 years. Furthermore, its impact on presurgical mood and anxiety disorders has not been investigated. The objectives of this study were (1) to identify seizure outcome changes over a period ranging from 18 to 81 months; (2) to investigate the seizure-free rate in the last follow-up year; (3) to identify the variables associated with seizure freedom; and (4) to identify the impact of LiTT on presurgical mood and anxiety disorders. Methods: Medical records of all patients who underwent LiTT for MTLE from 2013 to 2019 at the University of Miami Comprehensive Epilepsy Center were retrospectively reviewed. Demographic, epilepsy-related, cognitive, psychiatric, and LiTT-related data were compared between seizure-free (Engel Class I) and non-seizure-free (Engel Class II + III + IV) patients. Statistical analyses included univariate and multivariate stepwise logistic regression analyses.Results: Forty-eight patients (mean age = 43 ± 14.2 years, range = 21-78) were followed for a mean period of 50 ± 20.7 months (range = 18-81); 29 (60.4%) achieved an Engel Class I outcome, whereas 11 (22.9%) had one to three seizures/ year. Seizure-freedom rate decreased from 77.8% to 50% among patients with 24and >61-month follow-up periods, respectively. In the last follow-up year, 83% of all patients were seizure-free. Seizure freedom was associated with having mesial temporal sclerosis (MTS), no presurgical focal to bilateral tonic-clonic seizures, and no psychopathology in the last follow-up year. Presurgical mood and/or anxiety disorder were identified in 30 patients (62.5%) and remitted after LiTT in 19 (62%).Significance: LiTT appears to be a safe and effective surgical option for treatmentresistant MTLE, particularly among patients with MTS. Remission of presurgical mood and anxiety disorders can also result from LiTT.

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Magnetic Resonance–Guided Laser Interstitial Thermal Therapy for Mesial Temporal Epilepsy: A Case Series Analysis of Outcomes and Complications at 2-Year Follow-Up

Cited by 22 publications

References 27 publications

Two‐trajectory laser amygdalohippocampotomy: Anatomic modeling and initial seizure outcomes

Two‐trajectory laser amygdalohippocampotomy: Anatomic modeling and initial seizure outcomes

Resective, Ablative and Radiosurgical Interventions for Drug Resistant Mesial Temporal Lobe Epilepsy: A Systematic Review and Meta-Analysis of Outcomes

Long‐term seizure and psychiatric outcomes following laser ablation of mesial temporal structures

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