Abstracts

Rationale: Laser interstitial thermal therapy (LITT) is a minimally invasive surgical technique with the potential for targeted ablation of a seizure focus. Emerging data indicates favorable outcomes with regards to seizure control with less risk for surgical complications with shorter recovery period in TLE patients undergoing LITT.






Methods: A retrospective analysis was conducted on a cohort of 38 patients with medically refractory mesial or neocortical TLE who underwent LITT in our center. Postoperative primary outcome measures included seizure frequency reduction and International League Against Epilepsy (ILAE) surgical outcomes between 6 to 48 months. Secondary outcome measures included average hospital stay, persistent/transient complications and patient satisfaction.


Results: The mean baseline seizure frequency was 4.2 per month. Following LITT there was significant improvement in overall seizure burden with mean monthly seizure frequency of 0.5 at 6 months, 0.8 at 6-12 months, 0.6 at 12-24 months, and 0.9 at 24-48 months.

In overall cohort, percentage of patients who achieved ILAE Class 1-2 outcomes were 63% at 6 months, 53% at 6-12 months, 62% at 12-24 months, and 57% at 24-48 months. The percentage of patients who achieved ILAE Class 3-4 outcomes were 32% at 6 months, 44% at 6-12 months, 38% at 12-24 months, and 37% at 24-48 months. While 4 patients experienced worsening of their seizures with ILAE Class 5.

The average hospital stay for LITT procedure was 1.36 days. 6 patients (16%) experienced temporary complications with 2 of them being asymptomatic intracranial hemorrhage. 8 patients (21%) experienced persistent complications due to surgery, the most common complaint being headache (n=5). Other persistent complications were mood complaints (n=2) and vision loss (n=2). There were no mortalities associated with LITT procedure. A significant majority of patients were satisfied with their outcome (80%) and stated that they would opt for LITT again if in the same position (83%).


Conclusions: The results of our retrospective study indicate that LITT can be an effective and safe surgical option for selected patients with medically refractory TLE. The significant reduction in seizure frequency observed at multiple postoperative intervals underscores the durability of LITT's therapeutic effects. Short length of average hospital stay reflects the minimally invasive nature of LITT.

Our outcomes were comparable to current literature evaluating open resective surgery and LITT for treatment of temporal lobe epilepsy, within the limitations of differences in study designs. The choice of LITT instead of open temporal lobectomy is one that requires careful consideration of patient specific factors, such as the size and location of the lesion/epileptogenic zone, or age, weighed against RCT evidence that open temporal lobectomy remains the gold standard in achieving seizure freedom.



Funding: None