Abstract Details

Title Real-Time MRI-Guided Stereotactic Laser Thermal Amygdalohippocampotomy (SLTAH) for Refractory Mesial Temporal Lobe Epilepsy

Topic Epilepsy

Presentation(s) (-)

Poster/Presentation
Number 007

Objective

Background Traditional open surgical techniques are effective for treating refractory mesial temporal lobe epilepsy (MTLE), but can be associated with cognitive deficits. Previous minimally invasive alternatives such as radiofrequency ablation lack real-time determination of lesion location and volume. We describe our experience using stereotactic laser induced thermal therapy with real-time thermal imaging in patients with intractable MTLE.

Design/Methods The study includes 9 procedures in 8 adult patients with refractory MTLE, half with mesial temporal sclerosis (MTS). The procedure consists of stereotactic insertion, under general anesthesia, of an optical fiber targeting anterior hippocampus and terminating in the amygdala. Laser-induced thermal energy is delivered during continuous MR imaging. Temperature-sensitive images with estimates of thermal damage are displayed in real-time. The first 2 patients (examined retrospectively) had lesions limited to the parahippocampal gyrus. The next 6 procedures (followed prospectively) had successful initial SLTAH. One of the initial 2 patients underwent subsequent successful repeat SLTAH.

Results In the first 2 patients, both without MTS, ablations limited to the parahippocampal gyrus did not yield seizure-freedom. The subsequent 7 procedures (prospective) produced successful anterior amygdalohippocampotomies. Of the 4 with MTS, 3 [M1] were Engel class I (free of disabling seizures), and the 4th was Engel class II (rare disabling seizures) at 6 months. Of the 3 patients without MTS, 2 were Engel class II, and the 3rd was Engel class IV (unchanged) at 6 months. The patient who underwent a redo SLTAH had unexpected homonymous hemianopsia.

Conclusions SLTAH is a feasible surgical technique for refractory MTLE. Preliminary results indicate seizure outcomes might differ in patients with and without MTS. The safety and efficacy of SLTAH needs to be evaluated with larger cohorts over time.

Authors/Disclosures
Pearce J. Korb, MD, FAAN (VCU Health) PRESENTER	Dr. Korb has received personal compensation in the range of $500-$4,999 for serving as a CME Speaker with Medical ��ɫ�� Resources.
Jon T. Willie, MD, PhD (Emory University)	Jon T. Willie, MD, PhD has received personal compensation in the range of $0-$499 for serving as a Consultant for AiM Medical. Jon T. Willie, MD, PhD has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Medtronic. Jon T. Willie, MD, PhD has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Neuropace.
	No disclosure on file
Amit Saindane	No disclosure on file
	No disclosure on file
	No disclosure on file
Robert Gross	No disclosure on file
William W. Seeley, MD	Dr. Seeley has received personal compensation in the range of $500-$4,999 for serving as a Consultant for GLG Council. Dr. Seeley has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Guidepoint Global Consulting. Dr. Seeley has received personal compensation in the range of $500-$4,999 for serving as a Consultant for BridgeBio. Dr. Seeley has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Biogen. Dr. Seeley has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Lyterian Therapeutics. The institution of Dr. Seeley has received research support from NIH. The institution of Dr. Seeley has received research support from Rainwater Charitable Foundation. The institution of Dr. Seeley has received research support from Bluefield Project to Cure FTD. The institution of Dr. Seeley has received research support from Chan-Zuckerberg Initiative.

��ɫ����

��ɫ����

��ɫ��

��ɫ��