Grewal Sanjeet S, Zimmerman Richard S, Worrell Gregory, Brinkmann Benjamin H, Tatum William O, Crepeau Amy Z, Woodrum David A, Gorny Krzysztof R, Felmlee Joel P, Watson Robert E, Hoxworth Joseph M, Gupta Vivek, Vibhute Prasanna, Trenerry Max R, Kaufmann Timothy J, Marsh W Richard, Wharen Robert E, Van Gompel Jamie J
Departments of1Neurosurgery.
Departments of2Neurological Surgery.
J Neurosurg. 2018 Jul 6;130(6):2055-2062. doi: 10.3171/2018.2.JNS171873. Print 2019 Jun 1.
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.
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. Pre-ablation 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.
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.
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.
尽管激光间质热疗（LiTT）仍处于应用早期，但它已越来越多地被用作内侧颞叶癫痫患者的手术选择。本研究旨在描述梅奥诊所3个癫痫手术中心接受LiTT治疗后的内侧颞叶消融体积和癫痫发作结果。
这是一项多中心、单机构的回顾性研究，回顾了2011年10月至2015年10月期间因药物难治性内侧颞叶癫痫接受LiTT治疗后的癫痫发作结果和消融体积。使用FreeSurfer测量海马体消融前和消融后的随访体积，并使用基于监督样条的边缘检测算法在术中MRI上测量消融组织的体积。为了确定癫痫发作结果，对无癫痫发作的患者和继续有癫痫发作的患者的结果进行了比较。
在研究期间，有23例患者接受了内侧颞叶LiTT治疗。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立方毫米。海马体的中位消融率为65%，杏仁核的中位消融率为43%。在最后一次随访时，这些患者中有11例（48%）无癫痫发作。消融体积与癫痫发作缓解之间无相关性（p = 0.69）。杏仁核（p = 0.28）或海马体（p = 0.82）的消融百分比与癫痫发作结果之间也无相关性。12例患者接受了计算机视野的正式测试。在接受测试的患者中，67%出现了视野变化。将5例有临床明显视野缺损的患者与其余队列进行比较，发现有视野缺损的患者和无视野缺损的患者在消融体积上无显著差异（p = 0.94）。有11例患者接受了随访神经心理学测试。在这组患者中，左侧手术患者的言语学习保留率为76%，右侧手术患者为89%。
在本研究中，LiTT后的消融体积与癫痫发作结果之间无显著相关性。视野缺损在接受正式测试的患者中很常见，与接受开放性颞叶切除术的患者情况类似。需要进一步研究来确定杏仁核 - 海马体消融的作用。
