Laser ablation for mesial temporal epilepsy: a multi-site, single institutional series
Laser ablation for mesial temporal epilepsy: a multi-site, single institutional series
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DOI：
10.3171/2018.2.jns171873
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发表时间：
2019-06-01
影响因子：
4.1
通讯作者：
Van Gompel, Jamie J.
中科院分区：
文献类型：
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作者：
Grewal, Sanjeet S.;Zimmerman, Richard S.;Van Gompel, Jamie J.
目的虽然激光间质热疗（LiTT）的应用尚处于早期阶段，但它已越来越多地被用作内侧颞叶癫痫患者的手术选择。本研究的目的是描述内侧颞叶消融量和癫痫发作的结果后，在马约诊所的3个epilepsy surgery centers.METHODS的LiTT这是一个多站点，单机构，回顾性审查癫痫发作的结果和消融量后，LiTT的药物难治性内侧颞叶癫痫2011年10月和2015年10月之间。使用FreeSurfer测量海马的消融前和消融后随访体积，并使用监督样条边缘检测算法在术中MRI上测量消融组织的体积。为了确定癫痫发作的结果，结果进行了比较，这些患者谁是癫痫发作免费和那些谁继续经历seizures.Results有23例患者在研究期间接受内侧颞叶LiTT。15例患者（65%）接受了左侧手术。中位随访时间为34个月（范围12-70个月）。平均消融体积为6888 mm 3。中位海马消融为65%，中位杏仁核消融为43%。在末次随访时，这些患者中有11例（48%）无癫痫发作。消融量与无癫痫发作之间无相关性（p = 0.69）。杏仁核（p = 0.28）或海马（p = 0.82）消融百分比与癫痫发作结局之间也无相关性。12例患者接受了计算视野的正式测试。67%的接受测试的患者观察到视野变化。将5例具有临床显著视野缺损的患者与队列中的其余患者进行比较，结果显示，具有视野缺损的患者与无视野缺损的患者之间的消融量无显著差异（p = 0.94）。有11例患者进行了随访神经心理学测试。在这一组中，语言学习的保留率为76%的患者与左侧程序和89%的患者与右侧procedures.CONCLUSIONS在这项研究中，有没有显着的相关性消融量后LiTT和癫痫发作的结果。视野缺陷在正式测试的患者中很常见，与接受开放性颞叶切除术治疗的患者非常相似。需要进一步的研究来确定杏仁核海马消融的作用。
OBJECTIVE Although it is still early in its application, laser interstitial thermal therapy (LiTT) has increasingly been employed as a surgical option for patients with mesial temporal lobe epilepsy. This study aimed to describe mesial temporal lobe ablation volumes and seizure outcomes following LiTT across the Mayo Clinic's 3 epilepsy surgery centers.METHODS This was a multi-site, single-institution, retrospective review of seizure outcomes and ablation volumes following LiTT for medically intractable mesial temporal lobe epilepsy between October 2011 and October 2015. Preablation and post-ablation follow-up volumes of the hippocampus were measured using FreeSurfer, and the volume of ablated tissue was also measured on intraoperative MRI using a supervised spline-based edge detection algorithm. To determine seizure outcomes, results were compared between those patients who were seizure free and those who continued to experience seizures.RESULTS There were 23 patients who underwent mesial temporal LiTT within the study period. Fifteen patients (65%) had left-sided procedures. The median follow-up was 34 months (range 12-70 months). The mean ablation volume was 6888 mm3. Median hippocampal ablation was 65%, with a median amygdala ablation of 43%. At last follow-up, 11 (48%) of these patients were seizure free. There was no correlation between ablation volume and seizure freedom (p = 0.69). There was also no correlation between percent ablation of the amygdala (p = 0.28) or hippocampus (p = 0.82) and seizure outcomes. Twelve patients underwent formal testing with computational visual fields. Visual field changes were seen in 67% of patients who underwent testing. Comparing the 5 patients with clinically noticeable visual field deficits to the rest of the cohort showed no significant difference in ablation volume between those patients with visual field deficits and those without (p = 0.94). There were 11 patients with follow-up neuropsychological testing. Within this group, verbal learning retention was 76% in the patients with left-sided procedures and 89% in those with right-sided procedures.CONCLUSIONS In this study, there was no significant correlation between the ablation volume after LiTT and seizure outcomes. Visual field deficits were common in formally tested patients, much as in patients treated with open temporal lobectomy. Further studies are required to determine the role of amygdalohippocampal ablation.