Laser interstitial thermal therapy for medically intractable mesial XXXX .

@entity1 @entity3877 @entity410 @entity1315 @entity1662
OBJECTIVE: To describe mesial temporal lobe ablated volumes, verbal memory, and surgical outcomes in @entity1 with medically intractable mesial @entity1315 (mTLE) treated with magnetic resonance imaging (MRI)-guided stereotactic laser interstitial thermal therapy (LiTT). METHODS: We prospectively tracked @entity410 outcome in 20 @entity1 at Thomas Jefferson University Hospital with drug-resistant mTLE who underwent MRI-guided LiTT from December 2011 to December 2014. Surgical outcome was assessed at 6 months, 1 year, 2 years, and at the most recent visit. Volume-based analysis of ablated mesial temporal structures was conducted in 17 @entity1 with @entity3877 ( @entity3877 ) and results were compared between the @entity410 -free and not @entity410 -free groups. RESULTS: Following LiTT, proportions of @entity1 who were free of @entity410 impairing @entity1662 (including those with auras only) are as follows: 8 of 15 @entity1 (53%, 95% confidence interval [CI] 30.1-75.2%) after 6 months, 4 of 11 @entity1 (36.4%, 95% CI 14.9-64.8%) after 1 year, 3 of 5 @entity1 (60%, 95% CI 22.9-88.4%) at 2-year follow-up. Median follow-up was 13.4 months after LiTT (range 1.3 months to 3.2 years). @entity410 outcome after LiTT suggests an all or none response. Four @entity1 had anterior temporal lobectomy (ATL) after LiTT; three are @entity410 -free. There were no differences in total ablated volume of the amygdalohippocampus complex or individual volumes of hippocampus, amygdala, entorhinal cortex, parahippocampal gyrus, and fusiform gyrus between @entity410 -free and non- @entity410 -free @entity1 . Contextual verbal memory performance was preserved after LiTT, although decline in noncontextual memory task scores were noted. SIGNIFICANCE: We conclude that MRI-guided stereotactic LiTT is a safe alternative to ATL in @entity1 with medically intractable mTLE. Individualized assessment is warranted to determine whether the reduced odds of @entity410 freedom are worth the reduction in risk, discomfort, and recovery time. Larger prospective studies are needed to confirm our preliminary findings, and to define optimal ablation volume and ideal structures for ablation.
