Stereotactic MRI-guided laser interstitial thermal therapy for extratemporal lobe epilepsy

Area of Science:

• Neurosurgery
• Epileptology
• Medical Technology

Background:

• Extratemporal lobe epilepsy (ETLE) presents challenges for surgical treatment.
• Open resection may not be suitable for all ETLE patients.
• Magnetic resonance imaging (MRI)-guided laser interstitial thermal therapy (MRg-LITT) is an emerging alternative.

Purpose of the Study:

• To assess the safety and effectiveness of MRg-LITT for treating focal ETLE.
• To evaluate outcomes in patients with ETLE who are less favorable candidates for open surgery.
• To identify predictors of successful MRg-LITT outcomes in ETLE.

Main Methods:

• Retrospective review of 35 ETLE patients undergoing MRg-LITT (2012-2019).
• Epileptogenic zones identified using clinical data and stereoelectroencephalography (SEEG) ± imaging.
• Ablation volumes calculated via MRI; clinical outcomes assessed longitudinally.

Main Results:

• 53% of patients achieved good outcomes (Engel class I-II) with a mean follow-up of 27.3 months.
• Lesional ETLE and favorable SEEG seizure-onset patterns predicted better outcomes (p=0.02).
• Minor adverse events included transient neurological deficits; major events included brain abscess and hypothalamic obesity.

Conclusions:

• MRg-LITT is a well-tolerated and effective treatment for selected ETLE patients.
• Lesional epilepsy and specific SEEG findings are favorable prognostic indicators for MRg-LITT.
• MRg-LITT provides a viable surgical option for challenging ETLE cases.