Vivian L. Smith Department of Neurosurgery, McGovern Medical School, Houston, TX, USA.
Children's Learning Institute, University of Texas Health Science Center at Houston, Houston, TX, USA.
Epilepsia. 2018 Jul;59(7):1421-1432. doi: 10.1111/epi.14443. Epub 2018 Jun 12.
Laser interstitial thermal therapy (LITT) is a minimally invasive surgical technique for focal epilepsy. A major appeal of LITT is that it may result in fewer cognitive deficits, especially when targeting dominant hemisphere mesial temporal lobe (MTL) epilepsy. To evaluate this, as well as to determine seizure outcomes following LITT, we evaluated the relationships between ablation volumes and surgical or cognitive outcomes in 43 consecutive patients undergoing LITT for MTL epilepsy.
All patients underwent unilateral LITT targeting mesial temporal structures. FreeSurfer software was used to derive cortical and subcortical segmentation of the brain (especially subregions of the MTL) using preoperative magnetic resonance imaging (MRI). Ablation volumes were outlined using a postablation T1-contrasted MRI. The percentages of the amygdala, hippocampus, and entorhinal cortex ablated were quantified objectively. The volumetric measures were regressed against changes in neuropsychological performance before and after surgery, RESULTS: A median of 73.7% of amygdala, 70.9% of hippocampus, and 28.3% of entorhinal cortex was ablated. Engel class I surgical outcome was obtained in 79.5% and 67.4% of the 43 patients at 6 and 20.3 months of follow-up, respectively. No significant differences in surgical outcomes were found across patient subgroups (hemispheric dominance, hippocampal sclerosis, or need for intracranial evaluation). Furthermore, no significant differences in volumes ablated were found between patients with Engel class IA vs Engel class II-IV outcomes. In patients undergoing LITT in the dominant hemisphere, a decline in verbal and narrative memory, but not in naming function was noted.
Seizure-free outcomes following LITT may be comparable in carefully selected patients with and without MTS, and these outcomes are comparable with outcomes following microsurgical resection. Failures may result from non-mesial components of the epileptogenic network that are not affected by LITT. Cognitive declines following MTL-LITT are modest, and principally affect memory processes.
激光间质热疗（LITT）是一种针对局灶性癫痫的微创手术技术。LITT 的主要吸引力在于它可能导致较少的认知缺陷，特别是在针对优势半球内侧颞叶（MTL）癫痫时。为了评估这一点，并确定 LITT 后的癫痫发作结果，我们评估了 43 例连续接受 MTL 癫痫 LITT 治疗的患者的消融体积与手术或认知结果之间的关系。
所有患者均接受单侧 LITT 治疗，以靶向治疗内侧颞叶结构。术前磁共振成像（MRI）采用 FreeSurfer 软件对大脑进行皮质和皮质下分割（特别是 MTL 的亚区）。使用术后 T1 对比 MRI 描绘消融体积。客观量化杏仁核、海马体和内嗅皮层的消融百分比。体积测量与手术前后神经心理学表现的变化进行回归。
中位数为 73.7%的杏仁核、70.9%的海马体和 28.3%的内嗅皮层被消融。43 例患者中的 79.5%和 67.4%分别在 6 个月和 20.3 个月的随访中获得 Engel Ⅰ级手术结果。在优势半球接受 LITT 的患者中，在亚组患者（半球优势、海马硬化或需要颅内评估）之间未发现手术结果存在显著差异。此外，在 Engel Ⅰ级与 Engel Ⅱ-Ⅳ级结果的患者之间，消融体积无显著差异。在优势半球接受 LITT 的患者中，注意到言语和叙事记忆下降，但命名功能未下降。
在经过精心选择的有和无内侧颞叶结构（MTS）的患者中，LITT 后的无癫痫发作结果可能相似，这些结果与显微镜下切除的结果相似。失败可能是由于 LITT 无法影响的致痫网络的非内侧部分所致。MTL-LITT 后的认知下降是适度的，主要影响记忆过程。
