Robert E Gross1,2, Matthew A Stern3, Jon T Willie1,2, Rebecca E Fasano2, Amit M Saindane4, Bruno P Soares4, Nigel P Pedersen2, Daniel L Drane2,5,6. 1. Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA. 2. Department of Neurology, Emory University School of Medicine, Atlanta, GA. 3. Medical Scientist Training Program, Emory University School of Medicine, Atlanta, GA. 4. Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA. 5. Department of Neurology, University of Washington School of Medicine, Seattle, WA. 6. Department of Pediatrics, Emory University School of Medicine, Atlanta, GA.
Abstract
OBJECTIVE: To evaluate the outcomes 1 year and longer following stereotactic laser amygdalohippocampotomy for mesial temporal lobe epilepsy in a large series of patients treated over a 5-year period since introduction of this novel technique. METHODS: Surgical outcomes of a consecutive series of 58 patients with mesial temporal lobe epilepsy who underwent the surgery at our institution with at least 12 months of follow-up were retrospectively evaluated. A subgroup analysis was performed comparing patients with and without mesial temporal sclerosis. RESULTS: One year following stereotactic laser amygdalohippocampotomy, 53.4% (95% confidence interval [CI] = 40.8-65.7%) of all patients were free of disabling seizures (Engel I). Three of 9 patients became seizure-free following repeat ablation. Subgroup analysis showed that 60.5% (95% CI = 45.6-73.7%) of patients with mesial temporal sclerosis were free of disabling seizures as compared to 33.3% (95% CI = 15.0-58.5%) of patients without mesial temporal sclerosis. Quality of Life in Epilepsy-31 scores significantly improved at the group level, few procedure-related complications were observed, and verbal memory outcome was better than historical open resection data. INTERPRETATION: In an unselected consecutive series of patients, stereotactic laser amygdalohippocampotomy yielded seizure-free rates for patients with mesial temporal lobe epilepsy lower than, but comparable to, the outcomes typically associated with open temporal lobe surgery. Analogous to results from open surgery, patients without mesial temporal sclerosis fared less well. This novel procedure is an effective minimally invasive alternative to resective surgery. In the minority of patients not free of disabling seizures, laser ablation presents no barrier to additional open surgery. Ann Neurol 2018;83:575-587.
OBJECTIVE: To evaluate the outcomes 1 year and longer following stereotactic laser amygdalohippocampotomy for mesial temporal lobe epilepsy in a large series of patients treated over a 5-year period since introduction of this novel technique. METHODS: Surgical outcomes of a consecutive series of 58 patients with mesial temporal lobe epilepsy who underwent the surgery at our institution with at least 12 months of follow-up were retrospectively evaluated. A subgroup analysis was performed comparing patients with and without mesial temporal sclerosis. RESULTS: One year following stereotactic laser amygdalohippocampotomy, 53.4% (95% confidence interval [CI] = 40.8-65.7%) of all patients were free of disabling seizures (Engel I). Three of 9 patients became seizure-free following repeat ablation. Subgroup analysis showed that 60.5% (95% CI = 45.6-73.7%) of patients with mesial temporal sclerosis were free of disabling seizures as compared to 33.3% (95% CI = 15.0-58.5%) of patients without mesial temporal sclerosis. Quality of Life in Epilepsy-31 scores significantly improved at the group level, few procedure-related complications were observed, and verbal memory outcome was better than historical open resection data. INTERPRETATION: In an unselected consecutive series of patients, stereotactic laser amygdalohippocampotomy yielded seizure-free rates for patients with mesial temporal lobe epilepsy lower than, but comparable to, the outcomes typically associated with open temporal lobe surgery. Analogous to results from open surgery, patients without mesial temporal sclerosis fared less well. This novel procedure is an effective minimally invasive alternative to resective surgery. In the minority of patients not free of disabling seizures, laser ablation presents no barrier to additional open surgery. Ann Neurol 2018;83:575-587.
Authors: Jon T Willie; Nealen G Laxpati; Daniel L Drane; Ashok Gowda; Christina Appin; Chunhai Hao; Daniel J Brat; Sandra L Helmers; Amit Saindane; Sherif G Nour; Robert E Gross Journal: Neurosurgery Date: 2014-06 Impact factor: 4.654
Authors: Joon Y Kang; Chengyuan Wu; Joseph Tracy; Matthew Lorenzo; James Evans; Maromi Nei; Christopher Skidmore; Scott Mintzer; Ashwini D Sharan; Michael R Sperling Journal: Epilepsia Date: 2015-12-24 Impact factor: 5.864
Authors: D Jay McCracken; Jon T Willie; Brad A Fernald; Amit M Saindane; Daniel L Drane; Daniel L Barrow; Robert E Gross Journal: Oper Neurosurg (Hagerstown) Date: 2015-09-25 Impact factor: 2.703
Authors: Christianne N Heck; David King-Stephens; Andrew D Massey; Dileep R Nair; Barbara C Jobst; Gregory L Barkley; Vicenta Salanova; Andrew J Cole; Michael C Smith; Ryder P Gwinn; Christopher Skidmore; Paul C Van Ness; Gregory K Bergey; Yong D Park; Ian Miller; Eric Geller; Paul A Rutecki; Richard Zimmerman; David C Spencer; Alica Goldman; Jonathan C Edwards; James W Leiphart; Robert E Wharen; James Fessler; Nathan B Fountain; Gregory A Worrell; Robert E Gross; Stephan Eisenschenk; Robert B Duckrow; Lawrence J Hirsch; Carl Bazil; Cormac A O'Donovan; Felice T Sun; Tracy A Courtney; Cairn G Seale; Martha J Morrell Journal: Epilepsia Date: 2014-02-22 Impact factor: 5.864
Authors: Chengyuan Wu; Walter J Jermakowicz; Srijata Chakravorti; Iahn Cajigas; Ashwini D Sharan; Jonathan R Jagid; Caio M Matias; Michael R Sperling; Robert Buckley; Andrew Ko; Jeffrey G Ojemann; John W Miller; Brett Youngerman; Sameer A Sheth; Guy M McKhann; Adrian W Laxton; Daniel E Couture; Gautam S Popli; Alexander Smith; Ashesh D Mehta; Allen L Ho; Casey H Halpern; Dario J Englot; Joseph S Neimat; Peter E Konrad; Elliot Neal; Fernando L Vale; Kathryn L Holloway; Ellen L Air; Jason Schwalb; Benoit M Dawant; Pierre-Francois D'Haese Journal: Epilepsia Date: 2019-05-21 Impact factor: 5.864
Authors: Kelly R Bijanki; Sanne J H van Rooij; Timothy D Ely; Jennifer S Stevens; Cory S Inman; Rebecca E Fasano; Sierra E Carter; Sterling J Winters; Justin R Baman; Daniel L Drane; Tanja Jovanovic; Jon T Willie Journal: Neurosurgery Date: 2020-09-15 Impact factor: 4.654
Authors: Jon T Willie; James G Malcolm; Matthew A Stern; Lindsay O Lowder; Stewart G Neill; Brian T Cabaniss; Daniel L Drane; Robert E Gross Journal: Epilepsia Date: 2019-01-17 Impact factor: 5.864
Authors: Kunal Gupta; Brian Cabaniss; Ammar Kheder; Satyanarayana Gedela; Paul Koch; Kelsey C Hewitt; Abdulrahman Alwaki; Christopher Rich; Supriya Ramesha; Ranliang Hu; Daniel L Drane; Robert E Gross; Jon T Willie Journal: Epilepsia Date: 2020-08-10 Impact factor: 5.864
Authors: Abhijeet Gummadavelli; Dario J Englot; Jason M Schwalb; Chengyuan Wu; Jorge Gonzalez-Martinez; Joseph Niemat; Jason L Gerrard Journal: Neurosurgery Date: 2022-05-01 Impact factor: 5.315
Authors: Alexander A Hedaya; Kelsey C Hewitt; Ranliang Hu; Charles M Epstein; Robert E Gross; Daniel L Drane; Jon T Willie Journal: Epilepsy Behav Date: 2022-03-23 Impact factor: 3.337
Authors: Christin I Bermudez; Walter J Jermakowicz; John Paul G Kolcun; Samir Sur; Iahn Cajigas; Carlos Millan; Ramses Ribot; Enrique A Serrano; Naymee Velez-Ruiz; Merredith R Lowe; Leticia Tornes; Maru Palomeque; Andres M Kanner; Jonathan R Jagid; Gustavo J Rey Journal: Neurol Clin Pract Date: 2020-08