Department of Neurological Surgery, University of Washington, Seattle, Washington, USA.
Department of Biology, University of Washington, Seattle, Washington, USA.
Neurosurgery. 2022 Aug 1;91(2):347-354. doi: 10.1227/neu.0000000000002023. Epub 2022 May 6.
MRI-guided laser interstitial thermal therapy (MRgLITT) for mesial temporal lobe epilepsy is a safe, minimally invasive alternative to traditional surgical approaches. Prognostic factors associated with efficacy are debated; preoperative epilepsy duration and semiology seem to be important variables.
To determine whether acute postoperative seizure (APOS) after MRgLITT for mesial temporal lobe epilepsy is associated with seizure freedom/Engel class outcome at 1 year.
A single-institution retrospective study including adults undergoing first time MRgLITT for mesial temporal lobe epilepsy (2010-2019) with ≥1-year follow-up. Preoperative data included sex, epilepsy duration, number of antiepileptics attempted, weekly seizure frequency, seizure semiology, and radiographically verified anatomic lesion at seizure focus. Postoperative data included clinical detection of APOS within 7 days postoperatively, and immediate amygdala, hippocampal, entorhinal, and parahippocampal residual volumes determined using quantitative imaging postprocessing. Primary outcome was seizure freedom/Engel classification 1 year postoperatively.
Of 116 patients, 53% (n = 61) were female, with an average epilepsy duration of 21 (±14) years, average 6 failed antiepileptics (±3), and weekly seizure frequency of 5. APOS was associated with worse Engel class ( P = .010), conferring 6.3 times greater odds of having no improvement vs achieving seizure freedom at 1 year. Residual amygdala, hippocampal, entorhinal, and parahippocampal volumes were not statistically significant prognostic factors.
APOS was associated with a lower chance of seizure freedom at 1 year post-MRgLITT for mesial temporal lobe epilepsy. Amygdala, hippocampal, entorhinal, and parahippocampal residual volumes after ablation were not significant prognostic factors.
磁共振引导下激光间质热疗（MRgLITT）治疗内侧颞叶癫痫是一种安全、微创的替代传统手术方法。与疗效相关的预测因素存在争议；术前癫痫持续时间和症状学似乎是重要的变量。
确定磁共振引导下激光间质热疗治疗内侧颞叶癫痫后急性术后发作（APOS）是否与 1 年后的无癫痫发作/Engel 分级结果相关。
一项单中心回顾性研究，纳入 2010 年至 2019 年间首次接受内侧颞叶癫痫 MRgLITT 治疗且随访时间≥1 年的成年人。术前数据包括性别、癫痫持续时间、尝试的抗癫痫药物数量、每周发作频率、发作症状学以及在发作焦点处经放射学证实的解剖病变。术后数据包括术后 7 天内临床检测到的 APOS，以及使用定量成像后处理确定的即刻杏仁核、海马、内嗅皮质和海马旁回残留体积。主要结局是术后 1 年无癫痫发作/Engel 分级。
在 116 名患者中，53%（n=61）为女性，平均癫痫持续时间为 21（±14）年，平均 6 种抗癫痫药物治疗失败（±3），每周发作频率为 5。APOS 与较差的 Engel 分级相关（P=0.010），在 1 年内无改善与达到无癫痫发作的可能性相比，其概率降低了 6.3 倍。残留的杏仁核、海马、内嗅皮质和海马旁回体积不是统计学上显著的预后因素。
磁共振引导下激光间质热疗治疗内侧颞叶癫痫后 APOS 与 1 年内无癫痫发作的可能性降低相关。消融后的杏仁核、海马、内嗅皮质和海马旁回残留体积不是显著的预后因素。
