Comparing Laser Ablation vs Open Resection in Patients with Mesial Temporal Sclerosis Alone and Mesial Temporal Sclerosis Dual Pathology
Abstract number :
3.332
Submission category :
9. Surgery / 9B. Pediatrics
Year :
2022
Submission ID :
2205146
Source :
www.aesnet.org
Presentation date :
12/5/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:28 AM
Authors :
Kathryn Havens, PA-C – Children's National Hospital; Tayyba Anwar, MD – Children's National Hospital; Dewi Depositario Cabacar, MD – Children's National; William Gaillard, MD – Children's National; Archana Pasupuleti, MD – Children's National Hospital; Chima Oluigbo, MD – Children's National; John Schreiber, MD – Children's National; Thuy Vu, MD – Children's National Hospital; Matthew Whitehead, MD – Children's National
Rationale: Minimally invasive laser ablation and open resection surgery are procedures performed in patients with refractory mesial temporal lobe epilepsy. The purpose of this study was to examine the features and compare the surgical outcome of both procedures in patients with mesial temporal sclerosis (MTS) alone and MTS dual pathology (MTS plus) at our center.
Methods: We retrospectively identified patients who underwent epilepsy surgery from 2016 – 2021 with at least a 6 month follow up post op. Our IRB approved database was queried for demographics, MRI, surgery type, and Engel outcome.
Results: There were a total of 22 patients who underwent mesial temporal lobe epilepsy surgery. Five (23%) had laser ablation surgery and 17 (77%) had open resection surgery. Of the 5 who underwent laser ablation, the average age at surgery was 17.6 years old [range 6-33 years]. There were 3 patients with MTS only. One had Engel outcome 2 and 2 had Engel outcome 3. Of the 2 with an Engel outcome 3, 1 had a repeat laser ablation then had an Engel outcome 1. The other went on to have a stereo EEG and was found to have seizures coming from the residual amygdala. There were 2 with MTS plus. One (MTS plus stroke) had Engel outcome 3 followed by a repeat laser ablation and hemispherectomy and is now Engel 1. One adult patient (MTS plus multiple tubers plus possible focal cortical dysplasia (FCD) had an Engel 1 outcome.
Of the 17 who underwent open resection, the average age at surgery was 12.2 years old [range 2.5-19 years]. There were 4 with MTS only and 3 out of 4 (75%) had an Engel 1-2. One patient had an Engel 3 but the patient also had encephalitis aside from the MTS. There were 13 with MTS plus (MTS + FCD: 10; MTS + malformation of cortical development: 2; MTS + FCD + heterotopia: 1). Seven out of 13 (53%) had Engel 1 outcome, and 1 had Engel 2 (Engel 1 and Engel 2 = 61%). Two (15%) had Engel 3 & 4. The Engel 3 eventually developed spasms and atonic seizures, and likely has a genetic etiology. The Engel 4 had both generalized and focal features. A more localized malformation (MTS + FCD + heterotopia) did well with an Engel 1. Two had MTS with a more extensive malformation of cortical development and did less favorable (Engel 2 & 3).
Conclusions: This observational study compared surgical outcomes for patients with MTS alone and MTS dual pathology undergoing laser ablation vs open resection. Although limited in our numbers, when comparing laser ablation to resection, the open resection did better. In laser ablation, a better Engel outcome was seen in the adult patient compared to the pediatric. This study also showed that a repeat laser ablation can be considered with good outcome.
Funding: None
Surgery