Laser thermal ablation for mesiotemporal epilepsy: Analysis of ablation volumes and trajectories

Walter J. Jermakowicz, Andres M Kanner, Samir Sur, Christina Bermudez, Pierre Francois D'Haese, John Paul G Kolcun, Iahn Cajigas, Rui Li, Carlos Millan, Ramses Ribot, Enrique A Serrano, Naymee Velez, Merredith Lowe, Gustavo Rey, Jonathan Jagid

Research output: Contribution to journalArticle

47 Citations (Scopus)

Abstract

Objective: To identify features of ablations and trajectories that correlate with optimal seizure control and minimize the risk of neurocognitive deficits in patients undergoing laser interstitial thermal therapy (LiTT) for mesiotemporal epilepsy (mTLE). Methods: Clinical and radiographic data were reviewed from a prospectively maintained database of all patients undergoing LiTT for the treatment of mTLE at the University of Miami Hospital. Standard preoperative and postoperative evaluations, including contrast-enhanced magnetic resonance imaging (MRI) and neuropsychological testing, were performed in all patients. Laser trajectory and ablation volumes were computed both by manual tracing of mesiotemporal structures and by nonrigid registration of ablation cavities to a common reference system based on 7T MRI data. Results: Among 23 patients with at least 1-year follow-up, 15 (65%) were free of disabling seizures since the time of their surgery. Sparing of the mesial hippocampal head was significantly correlated with persistent disabling seizures (p = 0.01). A lateral trajectory through the hippocampus showed a trend for poor seizure outcome (p = 0.08). A comparison of baseline and postoperative neurocognitive testing revealed areas of both improvement and worsening, which were not associated with ablation volume or trajectory. Significance: At 1-year follow-up, LiTT appears to be a safe and effective tool for the treatment of mTLE, although a longer follow-up period is necessary to confirm these observations. Better understanding of the impact of ablation volume and location could potentially fine-tune this technique to improve seizure-freedom rates and associated neurologic and cognitive changes.

Original languageEnglish (US)
JournalEpilepsia
DOIs
StateAccepted/In press - 2017

Fingerprint

Laser Therapy
Epilepsy
Seizures
Hot Temperature
Lasers
Magnetic Resonance Imaging
Therapeutics
Nervous System
Hippocampus
Head
Databases

Keywords

  • Amygdala
  • Deformable atlas
  • Hippocampus
  • Memory
  • Volumetric analysis

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

Cite this

Laser thermal ablation for mesiotemporal epilepsy : Analysis of ablation volumes and trajectories. / Jermakowicz, Walter J.; Kanner, Andres M; Sur, Samir; Bermudez, Christina; D'Haese, Pierre Francois; Kolcun, John Paul G; Cajigas, Iahn; Li, Rui; Millan, Carlos; Ribot, Ramses; Serrano, Enrique A; Velez, Naymee; Lowe, Merredith; Rey, Gustavo; Jagid, Jonathan.

In: Epilepsia, 2017.

Research output: Contribution to journalArticle

Jermakowicz, WJ, Kanner, AM, Sur, S, Bermudez, C, D'Haese, PF, Kolcun, JPG, Cajigas, I, Li, R, Millan, C, Ribot, R, Serrano, EA, Velez, N, Lowe, M, Rey, G & Jagid, J 2017, 'Laser thermal ablation for mesiotemporal epilepsy: Analysis of ablation volumes and trajectories', Epilepsia. https://doi.org/10.1111/epi.13715
Jermakowicz, Walter J. ; Kanner, Andres M ; Sur, Samir ; Bermudez, Christina ; D'Haese, Pierre Francois ; Kolcun, John Paul G ; Cajigas, Iahn ; Li, Rui ; Millan, Carlos ; Ribot, Ramses ; Serrano, Enrique A ; Velez, Naymee ; Lowe, Merredith ; Rey, Gustavo ; Jagid, Jonathan. / Laser thermal ablation for mesiotemporal epilepsy : Analysis of ablation volumes and trajectories. In: Epilepsia. 2017.
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T1 - Laser thermal ablation for mesiotemporal epilepsy

T2 - Analysis of ablation volumes and trajectories

AU - Jermakowicz, Walter J.

AU - Kanner, Andres M

AU - Sur, Samir

AU - Bermudez, Christina

AU - D'Haese, Pierre Francois

AU - Kolcun, John Paul G

AU - Cajigas, Iahn

AU - Li, Rui

AU - Millan, Carlos

AU - Ribot, Ramses

AU - Serrano, Enrique A

AU - Velez, Naymee

AU - Lowe, Merredith

AU - Rey, Gustavo

AU - Jagid, Jonathan

PY - 2017

Y1 - 2017

N2 - Objective: To identify features of ablations and trajectories that correlate with optimal seizure control and minimize the risk of neurocognitive deficits in patients undergoing laser interstitial thermal therapy (LiTT) for mesiotemporal epilepsy (mTLE). Methods: Clinical and radiographic data were reviewed from a prospectively maintained database of all patients undergoing LiTT for the treatment of mTLE at the University of Miami Hospital. Standard preoperative and postoperative evaluations, including contrast-enhanced magnetic resonance imaging (MRI) and neuropsychological testing, were performed in all patients. Laser trajectory and ablation volumes were computed both by manual tracing of mesiotemporal structures and by nonrigid registration of ablation cavities to a common reference system based on 7T MRI data. Results: Among 23 patients with at least 1-year follow-up, 15 (65%) were free of disabling seizures since the time of their surgery. Sparing of the mesial hippocampal head was significantly correlated with persistent disabling seizures (p = 0.01). A lateral trajectory through the hippocampus showed a trend for poor seizure outcome (p = 0.08). A comparison of baseline and postoperative neurocognitive testing revealed areas of both improvement and worsening, which were not associated with ablation volume or trajectory. Significance: At 1-year follow-up, LiTT appears to be a safe and effective tool for the treatment of mTLE, although a longer follow-up period is necessary to confirm these observations. Better understanding of the impact of ablation volume and location could potentially fine-tune this technique to improve seizure-freedom rates and associated neurologic and cognitive changes.

AB - Objective: To identify features of ablations and trajectories that correlate with optimal seizure control and minimize the risk of neurocognitive deficits in patients undergoing laser interstitial thermal therapy (LiTT) for mesiotemporal epilepsy (mTLE). Methods: Clinical and radiographic data were reviewed from a prospectively maintained database of all patients undergoing LiTT for the treatment of mTLE at the University of Miami Hospital. Standard preoperative and postoperative evaluations, including contrast-enhanced magnetic resonance imaging (MRI) and neuropsychological testing, were performed in all patients. Laser trajectory and ablation volumes were computed both by manual tracing of mesiotemporal structures and by nonrigid registration of ablation cavities to a common reference system based on 7T MRI data. Results: Among 23 patients with at least 1-year follow-up, 15 (65%) were free of disabling seizures since the time of their surgery. Sparing of the mesial hippocampal head was significantly correlated with persistent disabling seizures (p = 0.01). A lateral trajectory through the hippocampus showed a trend for poor seizure outcome (p = 0.08). A comparison of baseline and postoperative neurocognitive testing revealed areas of both improvement and worsening, which were not associated with ablation volume or trajectory. Significance: At 1-year follow-up, LiTT appears to be a safe and effective tool for the treatment of mTLE, although a longer follow-up period is necessary to confirm these observations. Better understanding of the impact of ablation volume and location could potentially fine-tune this technique to improve seizure-freedom rates and associated neurologic and cognitive changes.

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KW - Deformable atlas

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KW - Memory

KW - Volumetric analysis

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