5-Year Surgical Outcomes of Laser Interstitial Thermal Therapy and Anterior Temporal Lobectomy in a Longitudinal Cohort
Abstract number :
3.476
Submission category :
9. Surgery / 9A. Adult
Year :
2025
Submission ID :
1467
Source :
www.aesnet.org
Presentation date :
12/8/2025 12:00:00 AM
Published date :
Authors :
Presenting Author: Kristine Ziemba, MD, PhD – University of Virginia Health
Matthew Rumschlag, MD – University of Virginia Health
Patrick Hartnett, MD – University of Virginia
Ifrah Zawar, MD MS-CR – University of Virginia Heatlh
Mark Quigg, MD – University of Virginia
W. Jeffrey Elias, MD – University of Virginia Heatlh
Shayan Moosa, MD – University of Virginia Heatlh
Anthony Longoria, PhD – University of Virginia Health
Racheal Smetana, PsyD, ABPP – University of Virginia Health
Nathan Fountain, MD – University of Virginia Heatlh
Rationale: Recent studies of outcomes following laser interstitial thermal therapy (LITT) for the treatment for drug resistant mesial temporal lobe epilepsy (MTLE) suggest lower rates of seizure freedom compared to historical rates of seizure freedom after anterior temporal lobectomy (ATL). National trends suggest LITT is becoming more common than ATL due to its minimally invasive approach and possibility of better cognitive outcomes, but some centers still prefer ATL over LITT because of perceived better seizure freedom rates. Here we provide comparative ATL and LITT surgical outcomes with seizure freedom rates in a retrospective longitudinal cohort of epilepsy surgeries at the University of Virginia before and after the implementation of LITT.
Methods: This is a single center, retrospective cohort study of patients who underwent temporal lobe surgery (ATL or LITT) for drug resistant MTLE between 2013 and 2023 at the University of Virginia. Patients were identified from an institutional prospective database of epilepsy surgeries with data entered at the time of initial surgery evaluation. Clinical data was also obtained from institutional epilepsy surgery quality conferences during which outcomes were regularly reviewed, and retrospective chart review. The primary outcomes were Engel class I seizure outcomes at 1-5 years post-surgery. We excluded patients without at least 1 year of follow-up, surgery involving other than standard mesial temporal lobe targets, or if the procedure was for tumor resection. We compared continuous variables using t-tests and categorical variables using Pearson Chi-squared tests or Fisher exact tests.
Results: There were 56 patients who met the inclusion criteria (38 LITT, and 18 ATL). The average age was 39 for the LITT cohort and 40 for ATL (p=0.8113). There were no group differences in terms of age, sex or surgery side. Engel I outcome at 1 year of follow-up was achieved in 76.3% in the LITT cohort and 88.9% in the ATL cohort (p=0.557). Engel I outcome at 5 years of follow-up (N=16 LITT and N=12 ATL with 5 years of follow-up available) was achieved in 75.0% in the LITT cohort and 83.3% in the ATL cohort (p=0.947).
Conclusions: We found comparable outcomes for LITT and ATL continuing to 5 years. Although a larger dataset could reveal a numerical difference between them, the difference appears to be small, and we found the Engel class I rate for LITT is higher than generally reported in the literature. This may be due to the highly selected nature of patients in the cohort, differences in surgical technique, differences in postsurgical follow up and management, or a combination of these factors. Limitations include single-center experience. Considering likely advantages of lower costs, shorter inpatient length-of-stay, and possible cognitive sparing, the comparable long-term outcomes for LITT and ATL groups suggest LITT may be considered as the treatment of choice for appropriately selected patients with MTLE.
Funding: None
Surgery