Long-term Outcomes of Stereotactic Radiofrequency Amygdalohippocampotomy for Temporal Lobe Epilepsy
Abstract number :
1.445
Submission category :
9. Surgery / 9A. Adult
Year :
2024
Submission ID :
1009
Source :
www.aesnet.org
Presentation date :
12/7/2024 12:00:00 AM
Published date :
Authors :
Presenting Author: Ryan Wang, MD – Western University
Andrew G Parrent, MD, RCPSC – Western University, London Ontario Canada
David Steven, MD, MPH, FRCSC, FACS – Western University
Jorge Burneo, MD, MSPH, FAAN, FAES, FRCPC – Western University, London Ontario Canada
Ana Suller-Marti, MD, PhD – Schulich School of Medicine and Dentistry Western University London Health Sciences Center
Jonathan Lau, MD, PhD, FRCSC – Western University, London Ontario Canada
Rationale: Radiofrequency (RF) ablation is a minimally-invasive procedure that has been used for treating medically-refractory epilepsy. However, the long-term efficacy of RF ablation has not been well-characterized, nor have the techniques been standardized. Given the resurgence of interest in ablative treatment of epilepsy, we aim to characterize the long-term outcomes of patients from the original series by Parrent and Blume (1999) describing stereotactic RF amygdalohippocampotomy (RFAH) for temporal lobe epilepsy (TLE).
Methods: Consecutive patients who underwent stereotactic RFAH for TLE were retrospectively reviewed. The procedure was conducted in the operating room via a lateral approach using a stereotactic frame. Baseline demographics, procedural details, and post-operative seizure outcomes until last follow-up were abstracted. Information about additional treatments was collected, if available. Kaplan-Meier analysis was done to estimate seizure-freedom as a function of time after initial RFAH treatment.
Results: 27 patients underwent stereotactic RFAH from 1994 to 2002. There were 14 female (52%) patients and 24 (89%) had mesial temporal sclerosis on MRI. Mean age at time of RFAH was 33.1 years (range 12-45 years). Mean time to RFAH treatment was 19.6 years (range 5-39 years). 17 (63%) patients underwent left-sided RFAH and a mean of 24.3 lesions were made. 15 (56%) patients had further interventions: 4 (15%) patients underwent only repeat RFAH, 1 (4%) patient had repeat RFAH and anterior temporal lobectomy (ATL), and 10 (37%) patients underwent subsequent ATL only. Mean follow-up was 9.0 years (range 0.5-22.7 years). At last follow-up, 16 (59%) patients were seizure-free with 5 (19%) patients having received one RFAH treatment, 2 (7%) patients who received repeat RFAH, 1 (4%) patient who underwent repeat RFAH and ATL, and 8 (30%) patients who only underwent subsequent ATL. Post-RFAH, 6 (22%) patients had visual field deficits and 3 (11%) had asymptomatic hematomas.
Conclusions: Although long-term seizure-freedom rates appear inferior to ATL and laser ablation, this study provides historical context to modern minimally-invasive approaches for TLE including laser ablation and SEEG-guided RF ablation. Considering that this represents the original series describing the technique, stereotactic RFAH was demonstrated to have a reasonable safety profile, which would certainly be improved with experience and innovations in imaging and stereotaxy since the original series. As determined in subsequent studies, seizure outcomes could likely be improved using a longitudinal trans-occipital trajectory in addition to multiple trajectory ablation strategies.
Funding: None
Surgery