Technical challenges to anterior temporal lobectomy after laser interstitial thermal therapy for mesial temporal lobe...

Mesial temporal sclerosis (MTS) is a frequent cause of medically refractory epilepsy, for which laser interstitial thermal therapy (LITT) is an effective treatment. However, experience with the technical considerations posed by additional surgery after an initial LITT procedure is lacking. The authors present the case of a 12-year-old female with medically refractory temporal lobe epilepsy and left MTS who underwent LITT at a separate institution prior to referral. This patient had no change in early postoperative seizure control (Engel class IVB) and then her seizures worsened despite ongoing medical treatment (Engel class IVC). Post-LITT MRI revealed sparing of the mesial hippocampus head, a poor prognostic factor. The authors describe the technical details illustrated by this case of secondary, stereotactic electroencephalography-guided mesial temporal resection following LITT. The case was managed with anterior temporal lobectomy including the resection of residual hippocampus and amygdala.