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Laser thermal ablation for mesiotemporal epilepsy: Analysis of ablation volumes and trajectories
Author(s) -
Jermakowicz Walter J.,
Kanner Andres M.,
Sur Samir,
Bermudez Christina,
D'Haese PierreFrancois,
Kolcun John Paul G.,
Cajigas Iahn,
Li Rui,
Millan Carlos,
Ribot Ramses,
Serrano Enrique A.,
Velez Naymee,
Lowe Merredith R.,
Rey Gustavo J.,
Jagid Jonathan R.
Publication year - 2017
Publication title -
epilepsia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.687
H-Index - 191
eISSN - 1528-1167
pISSN - 0013-9580
DOI - 10.1111/epi.13715
Subject(s) - ablation , epilepsy , medicine , magnetic resonance imaging , neurocognitive , laser ablation , surgery , nuclear medicine , cardiology , radiology , cognition , laser , psychiatry , physics , optics
Summary Objective To identify features of ablations and trajectories that correlate with optimal seizure control and minimize the risk of neurocognitive deficits in patients undergoing laser interstitial thermal therapy (Li TT ) for mesiotemporal epilepsy ( mTLE ). Methods Clinical and radiographic data were reviewed from a prospectively maintained database of all patients undergoing Li TT for the treatment of mTLE at the University of Miami Hospital. Standard preoperative and postoperative evaluations, including contrast‐enhanced magnetic resonance imaging ( MRI ) and neuropsychological testing, were performed in all patients. Laser trajectory and ablation volumes were computed both by manual tracing of mesiotemporal structures and by nonrigid registration of ablation cavities to a common reference system based on 7T MRI data. Results Among 23 patients with at least 1‐year follow‐up, 15 (65%) were free of disabling seizures since the time of their surgery. Sparing of the mesial hippocampal head was significantly correlated with persistent disabling seizures (p = 0.01). A lateral trajectory through the hippocampus showed a trend for poor seizure outcome (p = 0.08). A comparison of baseline and postoperative neurocognitive testing revealed areas of both improvement and worsening, which were not associated with ablation volume or trajectory. Significance At 1‐year follow‐up, Li TT appears to be a safe and effective tool for the treatment of mTLE , although a longer follow‐up period is necessary to confirm these observations. Better understanding of the impact of ablation volume and location could potentially fine‐tune this technique to improve seizure‐freedom rates and associated neurologic and cognitive changes.