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Stereotactic laser amygdalohippocampotomy for mesial temporal lobe epilepsy
Author(s) -
Gross Robert E.,
Stern Matthew A.,
Willie Jon T.,
Fasano Rebecca E.,
Saindane Amit M.,
Soares Bruno P.,
Pedersen Nigel P.,
Drane Daniel L.
Publication year - 2018
Publication title -
annals of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.764
H-Index - 296
eISSN - 1531-8249
pISSN - 0364-5134
DOI - 10.1002/ana.25180
Subject(s) - temporal lobe , epilepsy , mesial temporal lobe epilepsy , medicine , epilepsy surgery , confidence interval , surgery , subgroup analysis , anterior temporal lobectomy , psychiatry
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