The Warren Alpert Medical School of Brown University, Providence, RI, USA; Department of Neurosurgery, Rhode Island Hospital, Providence, RI, USA.
Department of Neurosurgery, Rhode Island Hospital, Providence, RI, USA.
Epilepsy Behav. 2023 Sep;146:109365. doi: 10.1016/j.yebeh.2023.109365. Epub 2023 Jul 29.
In patients with treatment-refractory temporal lobe epilepsy (TLE), a single stereotactic laser interstitial thermotherapy (LITT) procedure is sometimes insufficient to ablate epileptogenic tissue, particularly the medial structures often implicated in TLE. In patients with seizure recurrence after initial ablation, the extent to which a second ablation may achieve improved seizure outcomes is uncertain. The objective of this study was to investigate the feasibility and potential efficacy of repeat LITT amygdalohippocampotomy as a worthwhile strategy for intractable temporal lobe epilepsy by quantifying changes to targeted mesial temporal lobe structures and seizure outcomes.
Patients who underwent two LITT procedures for drug-resistant mesial TLE at our institution were included in the study. Lesion volumes for both procedures were calculated by comparing post-ablation intraoperative sequences to preoperative anatomy. Clinical outcomes after the initial procedure and repeat procedure were classified according to Engel scores.
Five consecutive patients were included in this retrospective case series: 3 with right- and 2 with left-sided TLE. The median interval between LITT procedures was 294 days (range: 227-1918). After the first LITT, 3 patients experienced class III outcomes, 1 experienced a class IV, and 1 experienced a class IB outcome. All patients achieved increased seizure freedom after a second procedure, with class I outcomes (3 IA, 2 IB).
Repeat LITT may be sufficient to achieve satisfactory seizure outcomes in some individuals who might otherwise be considered for more aggressive resection or palliative neuromodulation. A larger study to establish the potential value of repeat LITT amygdalohippocampotomy vs. other re-operation strategies for persistent, intractable temporal lobe epilepsy is worth pursuing.
在治疗抵抗性颞叶癫痫（TLE）患者中，单次立体定向激光间质热疗（LITT）有时不足以消融致痫性组织，尤其是与 TLE 常有关的内侧结构。在初始消融后出现癫痫发作复发的患者中，第二次消融是否能改善癫痫发作结果尚不确定。本研究的目的是通过量化目标内侧颞叶结构和癫痫发作结果的变化，来研究重复 LITT 杏仁核海马切开术作为治疗耐药性颞叶癫痫的一种可行且潜在有效的策略的可行性和潜在疗效。
本研究纳入了在我院接受两次 LITT 治疗耐药性内侧 TLE 的患者。通过将术后术中序列与术前解剖进行比较，计算两次手术的病变体积。根据 Engel 评分对初始手术和重复手术的临床结果进行分类。
本回顾性病例系列研究纳入了 5 例连续患者：3 例右侧 TLE，2 例左侧 TLE。LITT 手术之间的中位间隔时间为 294 天（范围：227-1918 天）。第一次 LITT 后，3 例患者的结果为 III 级，1 例为 IV 级，1 例为 IB 级。所有患者在第二次手术后均获得了更高的癫痫无发作率，结果为 I 级（3 例 IA，2 例 IB）。
在某些可能需要更激进的切除或姑息性神经调节的患者中，重复 LITT 可能足以获得满意的癫痫发作结果。值得进一步开展更大规模的研究，以确定重复 LITT 杏仁核海马切开术与其他复发性手术策略在持续性、耐药性颞叶癫痫中的潜在价值。
