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Two-trajectory laser amygdalohippocampotomy: Anatomic modeling and initial seizure outcomes
David D Liu1, Peter M Lauro1,2, Ronald K Phillips1
1Department of Neurosurgery, The Warren Alpert Medical School, Brown University, Providence, RI, USA.
Epilepsia
|August 2, 2021
Summary
A novel two-trajectory laser interstitial thermal therapy (LITT) approach for mesial temporal lobe epilepsy (mTLE) significantly improved ablation of key brain structures. This method shows promise for better seizure control in patients with mTLE.
Area of Science:
- Neurosurgery
- Epilepsy Research
- Medical Device Technology
Background:
- Mesial temporal lobe epilepsy (mTLE) is often treated with laser interstitial thermal therapy (LITT).
- Current single-trajectory LITT for mTLE faces challenges in simultaneously ablating critical medial temporal lobe (MTL) structures like the hippocampus, amygdala, and cortex due to their complex geometry.
- This limitation can impact treatment efficacy for epilepsy originating in these regions.
Purpose of the Study:
- To investigate the efficacy of a two-trajectory LITT approach compared to a single-trajectory method for targeting MTL structures in mTLE.
- To determine if a two-trajectory technique can achieve more comprehensive ablation of epileptogenic zones within the MTL.
- To validate the feasibility and initial outcomes of the two-trajectory LITT in a patient cohort.
Main Methods:
- Subject-specific computational models of the MTL (hippocampus, amygdala, piriform/entorhinal/perirhinal cortex) were created using Human Connectome Project MRI data.
- An algorithm identified and compared optimal single-trajectory and two-trajectory (hippocampal axis and amygdala-piriform axis) LITT paths.
- The proportion of each structure ablated at various thermal radii was evaluated, and the two-trajectory approach was applied to 11 mTLE patients.
Main Results:
- Computer simulations demonstrated the superiority of the two-trajectory approach over the single-trajectory method for ablating hippocampal subfields and amygdala nuclei across most burn radii (p < .05).
- Two-laser trajectories achieved complete ablation of MTL cortical structures at realistic thermal doses, which was not possible with single-trajectory LITT.
- In the patient cohort, 5 patients with >1 year follow-up achieved Engel class I outcomes, and 6 patients with shorter follow-up are on track for similar results.
Conclusions:
- The two-trajectory LITT amygdalohippocampotomy technique offers a potentially more effective method for ablating target structures in mTLE.
- Initial clinical results suggest this approach may lead to excellent seizure outcomes.
- Further research is warranted to confirm the long-term efficacy and safety of this advanced LITT strategy.
