Laser Interstitial Thermal Therapy for Mesial Temporal Lobe Epilepsy: Multicenter Study in 268 Consecutively Treated Patients Including Outcomes of Subsequent Temporal Lobectomy for Seizure Recurrence
Abstract number :
2.249
Submission category :
9. Surgery / 9A. Adult
Year :
2021
Submission ID :
1826022
Source :
www.aesnet.org
Presentation date :
12/5/2021 12:00:00 PM
Published date :
Nov 22, 2021, 06:51 AM
Authors :
Brett Youngerman, MD, MS - Columbia University Medical Center; Matei Banu - Neurological Surgery - Columbia University Medical Center; Farhan Khan - Neurological Surgery - Columbia University Medical Center; Guy McKhann - Neurological Surgery - Columbia University Medical Center; Catherine Schevon - Neurology - Columbia University Medical Center; Jonathan Jagid - Neurological Surgery - Jackson Memorial Hospital, University of Miami; Iahn Cajigas - Neurological Surgery - Jackson Memorial Hospital, University of Miami; Christian Theodotou - Neurological Surgery - Jackson Memorial Hospital, University of Miami; Andrew Ko - Neurological Surgery - Harborview Medical Center, University of Washington; Jeffrey Ojemann - Neurological Surgery - Harborview Medical Center, University of Washington; John Miller - Neurology - Harborview Medical Center, University of Washington; Adrian Laxton - Neurological Surgery - Wake Forest University School of Medicine; Daniel Couture - Neurological Surgery - Wake Forest University School of Medicine; Gautam Popli - Neurology - Wake Forest University School of Medicine; Vivek Buch - Neurological Surgery - Stanford Neuroscience Health Center; Casey Halpern - Neurological Surgery - Stanford Neuroscience Health Center; Scheherazade Le - Neurology - Stanford Neuroscience Health Center; Ashwini Sharan - Neurological Surgery - Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University; Michael Sperling - Neurological Surgery - Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University; Ashesh Mehta - Neurological Surgery - Zucker School of Medicine at Hofstra Northwell; Dario Englot - Neurological Surgery - Vanderbilt University; Joseph Neimat - Neurological Surgery - University of Louisville; Peter Konrad - Neurological Surgery - Vanderbilt University; Sameer Sheth - Neurological Surgery - Baylor College of Medicine; Elliot Neal - Neurological Surgery - University of South Florida Health South Tampa Center; Fernando Vale - Neurological Surgery - University of South Florida Health South Tampa Center; Kathryn Holloway - Neurological Surgery - Virginia Commonwealth University; Ellen Air - Neurological Surgery - Henry Ford Health System; Jason Schwalb - Neurological Surgery - Henry Ford Health System; Pierre-François D’Haese - Rockefeller Neuroscience Institute, West Virginia University; Chengyuan Wu - Neurological Surgery - Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University
Rationale: Laser interstitial thermal therapy (LITT) is growing in popularity as a minimally invasive, first-line alternative to open surgical resection for mesial temporal lobe epilepsy (mTLE). Reported rates of seizure freedom at 1-year are highly variable, ranging from 36-78%, and long-term durability is largely unknown. Anterior temporal lobectomy (ATL) remains an option for patients with LITT treatment failure. However, the safety and efficacy of this staged strategy have not been reported. We therefore collected longer and more complete follow-up on our previously published multi-center series of LITT for mTLE and also present outcomes for those patients who failed LITT and underwent subsequent ATL.
Methods: This multicenter, retrospective cohort study included 268 patients treated consecutively at 11 centers with LITT for MTLE between 2012-2018. Preoperative variables were evaluated for association with Engel I and Engel I or II outcomes at 1 year, 2 years, and last follow-up using logistic regression and with time to recurrence using Cox proportional hazards model. Outcomes and complications of subsequent ATL are also reported.
Results: Median follow-up was 47 months (range 12-95, IQR 31-61). Engel I outcome was achieved in 65.9% (170/258) at 6 months, 55.8% (149/267) a 1 year, 52.5% (126/240) at 2 years, and 49.3% (132/268) at last follow-up of at least 1 year. Engel I or II outcomes were achieved in 76.0% (196/258) at 6 months, 74.2% (198/267) at 1 year, 75.0% (180/240) at 2 years, and 66.0% (177/268) at last follow-up. Preoperative focal to bilateral tonic-clonic seizures were associated with decreased odds of Engel I outcome at 2 years (OR 0.59, 95% CI 0.37-0.98, p=0.042); decreased odds of Engel I or II outcome at 1 year (OR 0.53, 95% CI 0.30-0.92, p=0.022), 2 years (OR 0.53, 95% CI 0.29-0.98, p=0.041) and last follow-up (OR 0.52, 95% CI 0.30-0.87, p=0.013); and earlier non-Engel I or II outcome (HR 1.85, 95% CI 1.22-2.82, p=0.004). Younger patient age ( < 43-year median) was independently associated with earlier seizure recurrence (HR 1.41, 95% CI 0.99-2.01, p=0.043). Mesial temporal sclerosis (MTS) on MRI, dual MRI pathology, side of ablation, and intracranial monitoring were not associated with seizure outcomes or time to recurrence. Among 21 patients who failed LITT and underwent subsequent anterior temporal lobectomy, Engel I outcome was achieved in 65% (13/20) at 1 year, 10/15 (66.7%) at 2 years, and 65% (13/20) at last follow-up of at least 1 year (median 25, range 12-65, IQR 19.5-42 months). After ATL, 9.5% (2/21) experienced complications: 1 ipsilateral visual field deficit and 1 infection.
Surgery