Surgical Outcomes of Laser Interstitial Thermal Therapy and Anterior Temporal Lobectomy in a Longitudinal Series
Abstract number :
3.448
Submission category :
9. Surgery / 9A. Adult
Year :
2024
Submission ID :
547
Source :
www.aesnet.org
Presentation date :
12/9/2024 12:00:00 AM
Published date :
Authors :
Matthew Rumschlag, MD – University of Virginia Health System
Presenting Author: Patrick Hartnett, MD – University of Virginia
Ifrah Zawar, MD, MS-CR – University of Virginia
Mark Quigg, MD – University of Virginia
Jeff Elias, MD – University of Virginia
Racheal Smetana, PsyD – University of Virginia
Nathan Fountain, MD – University of Virginia
Rationale: Anterior temporal lobectomy (ATL) is associated with higher seizure freedom rates compared to historical rates for laser interstitial thermal therapy (LITT) for the treatment for drug resistant mesial temporal lobe epilepsy (MTLE). Nevertheless, national trends suggest LITT is becoming more common than ATL presumably because it is minimally invasive. However, some centers still prefer ATL over LITT because of perceived better seizure freedom rates. We compare ATL versus LITT seizure freedom rates and other outcomes in a consecutive sample of epilepsy surgeries at a single center before and after the implementation of LITT.
Methods: This is a single center, retrospective consecutive cohort of patients who underwent temporal lobe surgery for MTLE between January 2013-2023 at a major academic center. Data was obtained from a surgery database, institutional epilepsy surgery quality conferences, and chart review. The primary outcome were seizure outcomes at 1 and 2 years among the ATL and LiTT groups postsurgery. Exclusions were < 1 year follow-up, surgery other than mesial temporal targets, or pathology other than presumed hippocampal sclerosis. If repeat surgery occurred or insufficient postsurgery duration was present before 2-year outcome was established, then the patient was excluded from 2-year outcome analysis. We compared continuous variables using t-tests, and categorical variables were compared using Pearson Chi-squared tests or Fisher exact tests.
Results: 51 patients met the inclusion criteria (35 LITT (69%); 16 ATL (31%)). Five patients were excluded from 2 year follow up analysis because of insufficient follow-up duration. Neither age, sex, nor surgery side differed between groups (age LITT 38.67±14.88 vs ATL 40.50±15.56, p=0.70; women LITT 54% vs ATL 69%, p=0.33; side left LITT 60% vs ATL 50%, p=0.51). Neither seizure-freedom proportion at 1 year nor 2 years differed between groups (1 year LITT 80% vs ATL 88%, p=0.52; 2 years LITT 83% vs ATL 85.7%; p=0.84).
Conclusions: We found comparable outcomes for LITT and ATL at seizure freedom rates higher than generally reported. This may be due to patient selection, differences in surgical technique, or differences in postsurgical follow up and management, or a combination of these factors. LITT has several advantages, such as lower hospital costs, shorter length of stay, and is minimally invasive. Although limited by the retrospective nature and a single center experience, the comparable outcomes between LITT and ALT groups suggest LITT may be considered as the treatment of choice for appropriately selected patients with MTLE.
Funding: No funding.
Surgery