Abstract
Objective: Magnetic resonance (MR)-guided stereotactic laser amygdalohippocampectomy is a minimally invasive procedure for the treatment of refractory epilepsy in patients with mesial temporal sclerosis. Limited data exist on post-ablation volumetric trends associated with the procedure.Methods: 10 patients with mesial temporal sclerosis underwent MR-guided stereotactic laser amygdalohippocampectomy. Three independent raters computed ablation volumes at the following time points: pre-ablation (PreA), immediate post-ablation (IPA), 24 hours post-ablation (24PA), first follow-up post-ablation (FPA), and greater than three months follow-up post-ablation (>3MPA), using OsiriX DICOM Viewer (Pixmeo, Bernex, Switzerland). Statistical trends in post-ablation volumes were determined for the time points.Results: MR-guided stereotactic laser amygdalohippocampectomy produces a rapid rise and distinct peak in post-ablation volume immediately following the procedure. IPA volumes are significantly higher than all other time points. Comparing individual time points within each raters dataset (intra-rater), a significant difference was seen between the IPA time point and all others. There was no statistical difference between the 24PA, FPA, and >3MPA time points. A correlation analysis demonstrated the strongest correlations at the 24PA (r=0.97), FPA (r=0.95), and 3MPA time points (r=0.99), with a weaker correlation at IPA (r=0.92).Conclusion: MR-guided stereotactic laser amygdalohippocampectomy produces a maximal increase in post-ablation volume immediately following the procedure, which decreases and stabilizes at 24 hours post-procedure and beyond three months follow-up. Based on the correlation analysis, the lower inter-rater reliability at the IPA time point suggests it may be less accurate to assess volume at this time point. We recommend post-ablation volume assessments be made at least 24 hours post-selective ablation of the amygdalohippocampal complex (SLAH).
Highlights
Surgical resection is considered the “gold standard” for the treatment of medically refractoryHow to cite this article Carminucci A, Patel N V, Sundararajan S, et al (March 27, 2018) Volumetric Trends Associated with MRguided Stereotactic Laser Amygdalohippocampectomy in Mesial Temporal Lobe Epilepsy
selective ablation of the amygdalohippocampal complex (SLAH) is a potential alternative to anterior temporal lobectomy
Similar initial reports of SLAH have shown efficacious clinical results approaching those of anterior temporal lobectomy [20,15,17]
Summary
Surgical resection is considered the “gold standard” for the treatment of medically refractoryHow to cite this article Carminucci A, Patel N V, Sundararajan S, et al (March 27, 2018) Volumetric Trends Associated with MRguided Stereotactic Laser Amygdalohippocampectomy in Mesial Temporal Lobe Epilepsy. The most common surgical treatments include anterior temporal lobectomy (ATL) and selective amygdalohippocampectomy (SAH) [1]. Patients undergoing ATL achieve seizure-free outcomes, ranging from 60%-80% [2,3]. While these results are effective, they do not come without potentially significant morbidity to the patient. These side effects involve impairments in neurocognitive functioning, including deficits in naming and verbal memory when the procedure is performed in the dominant hemisphere [4]. Barriers to surgery include patients’ fear of invasive surgery, potential side effects, and the misconception that surgery should be considered last-resort treatment [5]
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