MRI-Guided stereotactic laser ablation for epilepsy surgery: Promising preliminary results for cognitive outcome

• Type of Material: Article
• Authors: Daniel L Drane, Emory University
• Language: English
• Date: 2018-05-01
• Publisher: Elsevier
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2017 Elsevier B.V. All rights reserved.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.eplepsyres.2017.09.016
• Title of Journal or Parent Work: Epilepsy Research
• ISSN: 0920-1211
• Volume: 142
• Start Page: 170
• End Page: 175
• Grant/Funding Information: Additionally, Dr. Drane has received a research grant from Medtronic, Inc. (A1225797BFN:1056035); and is also leading the core laboratory (neuroimaging and cognitive testing) for Medtronic's multisite trial of laser ablation (Stereotactic Laser Ablation for Temporal Lobe Epilepsy [SLATE]).; Dr. Drane has received three grants from the NIH/NINDS, which have supported his work in this area at both Emory University and the University of Washington (K23 NSO49100, K02 NS070960, R01NS088748).; These grants have provided salary support for Dr. Drane and his laboratory staff, and covered the cost of neuroimaging and other study related expenses.
• Keywords: NEURONAL-ACTIVITY; Laser interstitial thermal therapy; AMYGDALA; VERBAL MEMORY; LOBECTOMY; Naming; LITT; Epilepsy surgery; LESIONS; METAANALYSIS; Memory; Neurosciences & Neurology; Clinical Neurology; TEMPORAL-LOBE EPILEPSY; CORTEX; Life Sciences & Biomedicine; THERAPY; Cognitive outcome; FUNCTIONAL CONSIDERATIONS; Science & Technology
• Research Categories: Biology, Neuroscience; Health Sciences, Medicine and Surgery

Abstract

Cognitive outcome data are reviewed with respect to the use of magnetic-resonance guided stereotactic laser ablation (SLA) as an epilepsy surgical procedure, with comparisons drawn to traditional open resection procedures. Cognitive outcome with stereotactic laser amygdalohippocampotomy (SLAH) appears better than open resection for several functions dependent on extra-mesial temporal lobe (TL) structures, including category-related naming, verbal fluency, and object/familiar person recognition. Preliminary data suggests episodic, declarative verbal memory can decline following SLAH in the language dominant hemisphere, although early findings suggest comparable or even superior outcomes compared with open resection. The hippocampus has long been considered a central structure supporting episodic, declarative memory, with epilepsy surgical teams attempting to spare it whenever possible. However, ample data from animal and human neuroscience research suggests declarative memory deficits are greater following broader mesial TL lesions that include parahippocampal gyrus and lateral TL inputs. Therefore, employing a neurosurgical technique that restricts the surgical lesion zone holds promise for achieving a better cognitive outcome. Focal SLA lesions outside of the amygdalohippocampal complex may impair select cognitive functions, although few data have been published in such patients to date. SLA is being effectively employed with adults and children with TL or lesional epilepsies across several U.S. epilepsy centers, which may simultaneously optimize cognitive outcome while providing a curative treatment for seizures.