Long-Term Seizure Outcomes of Laser Interstitial Therapy (LITT) for Refractory Mesial Temporal Lobe Epilepsy in a Stanford Cohort
Abstract number :
3.332
Submission category :
9. Surgery / 9C. All Ages
Year :
2021
Submission ID :
1825502
Source :
www.aesnet.org
Presentation date :
12/6/2021 12:00:00 PM
Published date :
Nov 22, 2021, 06:44 AM
Authors :
Scheherazade Le, MD - Stanford University; Vivek Buch, MD - Neurosurgery - Stanford University; Allen Ho, MD - Neurosurgery - Stanford University; Jessica Falco-Walter, MD - Neurology-Epilepsy - Stanford University; Robert Fisher, MD, PhD - Neurology - Epilepsy - Stanford University; Jaimie Henderson, MD - Neurosurgery - Stanford University; Gerald Grant, MD - Pediatric Neurosurgery - Stanford Children's Health; Kimford Meador, MD - Neurology - Epilepsy - Stanford University; Casey Halpern, MD - Neurosurgery - Stanford University
Rationale: Laser Interstitial Thermal Therapy (LITT) is a minimally invasive alternative with less cognitive risks compared to traditional surgery for focal drug-resistant epilepsy. We describe long term seizure outcomes after LITT in our cohort with intractable mesial temporal lobe epilepsy (MTLE).
Methods: We prospectively tracked Stanford’s MTLE cases treated with LITT from 2014 – 2018 with at least 18 months follow up. A total of 48 patients underwent LITT: 5 patients excluded due to insufficient follow up, 6 patients excluded due to extra-temporal target, 1 patient excluded due to GAD65-Ab syndrome, 1 patient excluded because initial LITT was performed at an outside institution. Primary endpoint was seizure outcome by Engel classification. Secondary outcome was post-ablation complications.
Results: A total of 35 patients underwent selective amygdalohippocampectomy via LITT. Mesial temporal sclerosis (MTS) was present in 28 (80%). The age range was 17-70 years and 11 patients (31%) were > 50 years old. Median follow-up was 39 months (range 18-78 months). Left ablation was performed in 19 (54%). Three patients had prior surgery but none had prior neuromodulation devices. Invasive EEG was used in 8 subjects (23%). Engel Class I outcome was achieved in 19/35 (54%) with 13/35 (37%) Engel Class IA/IB. Class II was achieved by 9/35 (26%) and Class III by 7/35 (20%). No patients reported Engel Class IV outcomes; all showed worthwhile improvement. Twelve of the 28 (43%) patients who had MTS achieved Engel Class I.
Eight patients (24%) proceeded to subsequent procedures with good outcomes including repeat ipsilateral LITT (n = 6; 5/6 patients Engel Class I, 1/6 patients Engel Class III), conventional anterior temporal lobectomy (n = 1; Engel Class IA), and neuromodulation with responsive neurostimulation (RNS) (n = 1; Engel Class IB).
Complications included peri-operative seizures in 10/35 (29%) and non-seizure complaints in 11/35 (31%). Five (14%) had neurological deficits including one permanent partial superior quadrantanopsia, two transient complaints of diplopia, one transient trochlear nerve palsy and one oculomotor nerve palsy after repeat LITT.
Conclusions: Overall, Engel Class I outcome has been sustained in 54% of MTLE patients free of disabling seizures over a median of 39 months follow up. Complications usually were temporary, although there was one persistent visual field deficit. Patients should be counseled about possible post-operative seizures and cranial nerve palsies. Laser ablation is well-tolerated and offers a durable seizure reduction for the majority of patients.
Funding: Please list any funding that was received in support of this abstract.: Stereotactic Laser Ablation for Temporal Lobe Epilepsy (SLATE) trial.
Surgery