Stereotactic laser amygdalohippocampotomy for mesial temporal lobe epilepsy

• Type of Material: Article
• Authors: Robert Gross, Emory University; Matthew A. Stern, Emory University; Jon Willie, Emory University; Rebecca Fasano, Emory University; Amit Saindane, Emory University; Bruno Soares, Emory University; Nigel Pedersen, Emory University; Daniel Drane, Emory University
• Language: English
• Date: 2018-03-01
• Publisher: Wiley: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2018 American Neurological Association
• Final Published Version (URL): http://dx.doi.org/10.1002/ana.25180
• Title of Journal or Parent Work: Annals of Neurology
• ISSN: 0364-5134
• Volume: 83
• Issue: 3
• Start Page: 575
• End Page: 587
• Grant/Funding Information: This project was in part supported by a research grant from Visualase, Inc. [Agency Award #: VIS-10-001] and grants received by DLD from the National Institute of Neurological Disorders and Stroke (NINDS) of the National Institutes of Health (NIH) [K23 NSO49100, K02NS070960, R01NS088748], and Medtronic, Inc. [A1225797BFN:1056035].
• Keywords: Life Sciences & Biomedicine; Neurosciences & Neurology; SELECTIVE AMYGDALOHIPPOCAMPECTOMY; OUTCOMES; Science & Technology; SURGERY; HIPPOCAMPECTOMY; THERAPY; MEMORY; Neurosciences; TRIAL; Clinical Neurology; ABLATION; STIMULATION; ADULTS
• Research Categories: Biology, Neuroscience; Health Sciences, Medicine and Surgery

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.