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Updated: Sep 22, 2025
Anteromesial Temporal Lobectomy for Medically Intractable Temporal Lobe Epilepsy: An Operative Study
Published on: August 15, 2025
Piriform Cortex Ablation Volume Is Associated With Seizure Outcome in Mesial Temporal Lobe Epilepsy
Brian Y Hwang1, David Mampre1, Yohannes K Tsehay1
1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Background:
Growing evidence suggests that piriform cortex resection during anterior temporal lobectomy is important for achieving good seizure outcome in mesial temporal lobe epilepsy (mTLE). However, the relationship between seizure outcome and piriform cortex ablation during MR-guided laser interstitial thermal therapy (MRgLITT) remains unclear.
Objective:
To determine whether ablation of piriform cortex was associated with seizure outcome in patients with mTLE undergoing MRgLITT.
Methods:
We performed preablation and postablation volumetric analyses of hippocampus, amygdala, piriform cortex, and ablation volumes in patients with mTLE who underwent MRgLITT at our institution from 2014 to 2019.
Results:
Thirty nine patients with mTLE were analyzed. In univariate logistic regression, percent piriform cortex ablation was associated with International League Against Epilepsy (ILAE) class 1 at 6 months (odds ratio [OR] 1.051, 95% CI [1.001-1.117], P = .045), whereas ablation volume, percent amygdala ablation, and percent hippocampus ablation were not ( P > .05). At 1 year, ablation volume was associated with ILAE class 1 (OR 1.608, 95% CI [1.071-2.571], P = .021) while percent piriform cortex ablation became a trend (OR 1.050, 95% CI [0.994-1.109], P = .054), and both percent hippocampus ablation and percent amygdala ablation were not significantly associated with ILAE class 1 ( P > .05). In multivariable logistic regression, only percent piriform cortex ablation was a significant predictor of seizure freedom at 6 months (OR 1.085, 95% CI [1.012-1.193], P = .019) and at 1 year (OR 1.074, 95% CI [1.003-1.178], P = .041).
Conclusion:
Piriform cortex ablation volume is associated with seizure outcome in patients with mTLE undergoing MRgLITT. The piriform cortex should be considered a high yield ablation target to achieve good seizure outcome.
Insights
Ablating the piriform cortex during MR-guided laser interstitial thermal therapy (MRgLITT) for mesial temporal lobe epilepsy (mTLE) is linked to better seizure outcomes. This suggests the piriform cortex is a key target for effective seizure control.
Area of Science:
- Neurosurgery
- Epilepsy Research
- Medical Technology
Background:
- Mesial temporal lobe epilepsy (mTLE) is a common form of drug-resistant epilepsy.
- Piriform cortex resection during anterior temporal lobectomy improves seizure outcomes in mTLE.
- The role of piriform cortex ablation in MR-guided laser interstitial thermal therapy (MRgLITT) for mTLE is not well-defined.
Purpose of the Study:
- To investigate the association between piriform cortex ablation and seizure outcomes in mTLE patients treated with MRgLITT.
- To evaluate the piriform cortex as a potential target for improving seizure control in mTLE.
Main Methods:
- Volumetric analyses of hippocampus, amygdala, and piriform cortex were performed pre- and post-MRgLITT.
- Thirty-nine mTLE patients undergoing MRgLITT between 2014 and 2019 were analyzed.
- Logistic regression models (univariate and multivariable) assessed the relationship between ablation volumes and seizure outcomes (ILAE class 1 at 6 months and 1 year).
Main Results:
- Percent piriform cortex ablation was significantly associated with International League Against Epilepsy (ILAE) class 1 seizure outcome at 6 months (OR 1.051, P = .045).
- In multivariable analysis, piriform cortex ablation independently predicted seizure freedom at 6 months (OR 1.085, P = .019) and 1 year (OR 1.074, P = .041).
- Ablation volume was associated with seizure freedom at 1 year, but percent amygdala and hippocampus ablation were not significant predictors.
Conclusions:
- Piriform cortex ablation volume is a significant predictor of seizure outcome in mTLE patients treated with MRgLITT.
- The piriform cortex should be considered a high-yield target for MRgLITT to achieve favorable seizure outcomes in mTLE.
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