Visual deficit from laser interstitial thermal therapy for temporal lobe epilepsy: Anatomical considerations

Walter J. Jermakowicz, Michael E. Ivan, Iahn Cajigas, Ramses Ribot, Ignacio Jusue-Torres, Mehul Desai, Armando Ruiz, Pierre Francois D'Haese, Andres M Kanner, Jonathan Jagid

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

BACKGROUND: Laser interstitial thermal therapy (LITT) is quickly emerging as an effective surgical therapy for temporal lobe epilepsy (TLE). One of the most frequent complications of the procedure is postoperative visual field cuts, but the physiopathology of these deficits is unknown.OBJECTIVE: To evaluate potential causes of visual deficits after LITT for TLE in an attempt to minimize this complication.METHODS: This retrospective chart review compares the case of a 24-year-old male who developed homonymous hemianopsia following LITT for TLE to 17 prior patients who underwent the procedure and suffered no visual deficit. We examined both features of the surgical approach (trajectory, laser energy, ablation size) and of preoperative surgical anatomy, derived from volumetric tracings of mesiotemporal structures.RESULTS: For the patient with postoperative homonymous hemianopsia imaging suggested inadvertent ablation of the lateral geniculate nucleus, although the laser was positioned entirely within the hippocampus. This patient's laser trajectory, ablation number, energy delivered, and ablation size were not significantly different from the prior patients. However, the subject with the visual deficit did have significantly smaller choroidal fissure cerebrospinal fluid volume.CONCLUSION: Visual deficits are the most common complication of LITT for mesiotemporal epilepsy and patients at most risk may have small cerebrospinal fluid volume in the choroidal fissure, allowing heat to spread from the hippocampal body to the lateral geniculate nucleus. When such anatomy is identified on preoperative magnetic resonance imaging, we recommend lowering laser trajectory, decreasing ablation power through the hippocampal body, and using temperature safety markers at the lower thalamic border.

Original languageEnglish (US)
Pages (from-to)627-633
Number of pages7
JournalOperative Neurosurgery
Volume13
Issue number5
DOIs
StatePublished - Oct 1 2017

Fingerprint

Temporal Lobe Epilepsy
Lasers
Hot Temperature
Geniculate Bodies
Hemianopsia
Laser Therapy
Cerebrospinal Fluid
Anatomy
Therapeutics
Postoperative Care
Operative Time
Visual Fields
Body Temperature
Epilepsy
Hippocampus
Magnetic Resonance Imaging
Safety

Keywords

  • Diffusion tensor imaging
  • Hippocampus
  • Homonymous hemianopsia
  • Lateral geniculate nucleus
  • Mesiotemporal sclerosis

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Visual deficit from laser interstitial thermal therapy for temporal lobe epilepsy : Anatomical considerations. / Jermakowicz, Walter J.; Ivan, Michael E.; Cajigas, Iahn; Ribot, Ramses; Jusue-Torres, Ignacio; Desai, Mehul; Ruiz, Armando; D'Haese, Pierre Francois; Kanner, Andres M; Jagid, Jonathan.

In: Operative Neurosurgery, Vol. 13, No. 5, 01.10.2017, p. 627-633.

Research output: Contribution to journalArticle

Jermakowicz, Walter J. ; Ivan, Michael E. ; Cajigas, Iahn ; Ribot, Ramses ; Jusue-Torres, Ignacio ; Desai, Mehul ; Ruiz, Armando ; D'Haese, Pierre Francois ; Kanner, Andres M ; Jagid, Jonathan. / Visual deficit from laser interstitial thermal therapy for temporal lobe epilepsy : Anatomical considerations. In: Operative Neurosurgery. 2017 ; Vol. 13, No. 5. pp. 627-633.
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T2 - Anatomical considerations

AU - Jermakowicz, Walter J.

AU - Ivan, Michael E.

AU - Cajigas, Iahn

AU - Ribot, Ramses

AU - Jusue-Torres, Ignacio

AU - Desai, Mehul

AU - Ruiz, Armando

AU - D'Haese, Pierre Francois

AU - Kanner, Andres M

AU - Jagid, Jonathan

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N2 - BACKGROUND: Laser interstitial thermal therapy (LITT) is quickly emerging as an effective surgical therapy for temporal lobe epilepsy (TLE). One of the most frequent complications of the procedure is postoperative visual field cuts, but the physiopathology of these deficits is unknown.OBJECTIVE: To evaluate potential causes of visual deficits after LITT for TLE in an attempt to minimize this complication.METHODS: This retrospective chart review compares the case of a 24-year-old male who developed homonymous hemianopsia following LITT for TLE to 17 prior patients who underwent the procedure and suffered no visual deficit. We examined both features of the surgical approach (trajectory, laser energy, ablation size) and of preoperative surgical anatomy, derived from volumetric tracings of mesiotemporal structures.RESULTS: For the patient with postoperative homonymous hemianopsia imaging suggested inadvertent ablation of the lateral geniculate nucleus, although the laser was positioned entirely within the hippocampus. This patient's laser trajectory, ablation number, energy delivered, and ablation size were not significantly different from the prior patients. However, the subject with the visual deficit did have significantly smaller choroidal fissure cerebrospinal fluid volume.CONCLUSION: Visual deficits are the most common complication of LITT for mesiotemporal epilepsy and patients at most risk may have small cerebrospinal fluid volume in the choroidal fissure, allowing heat to spread from the hippocampal body to the lateral geniculate nucleus. When such anatomy is identified on preoperative magnetic resonance imaging, we recommend lowering laser trajectory, decreasing ablation power through the hippocampal body, and using temperature safety markers at the lower thalamic border.

AB - BACKGROUND: Laser interstitial thermal therapy (LITT) is quickly emerging as an effective surgical therapy for temporal lobe epilepsy (TLE). One of the most frequent complications of the procedure is postoperative visual field cuts, but the physiopathology of these deficits is unknown.OBJECTIVE: To evaluate potential causes of visual deficits after LITT for TLE in an attempt to minimize this complication.METHODS: This retrospective chart review compares the case of a 24-year-old male who developed homonymous hemianopsia following LITT for TLE to 17 prior patients who underwent the procedure and suffered no visual deficit. We examined both features of the surgical approach (trajectory, laser energy, ablation size) and of preoperative surgical anatomy, derived from volumetric tracings of mesiotemporal structures.RESULTS: For the patient with postoperative homonymous hemianopsia imaging suggested inadvertent ablation of the lateral geniculate nucleus, although the laser was positioned entirely within the hippocampus. This patient's laser trajectory, ablation number, energy delivered, and ablation size were not significantly different from the prior patients. However, the subject with the visual deficit did have significantly smaller choroidal fissure cerebrospinal fluid volume.CONCLUSION: Visual deficits are the most common complication of LITT for mesiotemporal epilepsy and patients at most risk may have small cerebrospinal fluid volume in the choroidal fissure, allowing heat to spread from the hippocampal body to the lateral geniculate nucleus. When such anatomy is identified on preoperative magnetic resonance imaging, we recommend lowering laser trajectory, decreasing ablation power through the hippocampal body, and using temperature safety markers at the lower thalamic border.

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KW - Lateral geniculate nucleus

KW - Mesiotemporal sclerosis

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