Accuracy and initial outcomes for stereotactic laser amygdalohippocampotomy using a fully MRI-compatible platform

Area of Science:

• Neurosurgery
• Epilepsy Treatment
• Minimally Invasive Procedures

Background:

• MRI-guided laser interstitial thermal therapy (MRgLITT) is an emerging treatment for epilepsy.
• Stereotactic laser amygdalohippocampotomy (SLAH) for mesial temporal lobe epilepsy (MTLE) shows promise for seizure control with potentially fewer neurocognitive side effects than open surgery.
• Existing SLAH studies report varied outcomes, necessitating further investigation into technique optimization and results.

Purpose of the Study:

• To present the largest single-center experience with SLAH for MTLE using a specific MRI-compatible targeting platform (ClearPoint).
• To analyze the accuracy of the targeting platform and identify intraoperative factors influencing complications and initial seizure control outcomes.

Main Methods:

• Retrospective analysis of 91 consecutive patients undergoing SLAH for MTLE between June 2013 and October 2019 at Emory University.
• Utilized a single MRI-compatible targeting platform (ClearPoint) for all procedures.
• Employed univariable statistical analyses (Student t-test, ANOVA, chi-square, Wilcoxon rank-sum) to correlate surgical characteristics with outcomes.

Main Results:

• Analysis included 91 patients (97 procedures, 114 trajectories); mean age 42.8 years, mean seizure onset 19.3 years.
• Mean target error was 1.2 mm, with significant improvement over time indicating a learning curve; entry-to-target distance did not correlate with error.
• At 12 months, 50.5% achieved Engel score I (seizure-free), 23.1% Engel score II, 17.6% Engel score III, and 5.5% Engel score IV.

Conclusions:

• This study represents the largest single-center experience with SLAH for MTLE using an MRI-compatible platform.
• The technique enables safe laser ablation of epileptogenic tissue, achieving seizure outcomes comparable to open surgical procedures.
• Further research is required to confirm advantages over other stereotactic methods and the long-term impact of repeat minimally invasive interventions.