Temporal Lobectomy for Seizure Recurrence Following Stereotactic Laser Amygdalohippocampotomy
Abstract number :
1.337
Submission category :
9. Surgery / 9C. All Ages
Year :
2021
Submission ID :
1826353
Source :
www.aesnet.org
Presentation date :
12/9/2021 12:00:00 PM
Published date :
Nov 22, 2021, 06:53 AM
Authors :
Jonathan Lau, MD, PhD, FRCSC - Western University; Dayton Grogan – Emory University; Pia Mendoza, MD – Emory University; Neal Laxpati, MD, PhD – Emory University; Daniel Drane, PhD – Emory University; Matthew Schniederjan, MD – Emory University; Katie Bullinger – Emory University; Jon Willie, MD, PhD – Emory University; Robert Gross, MD, PhD – Emory University
Rationale: Stereotactic laser amygdalohippocampotomy (SLAH) has been demonstrated to be a feasible, minimally invasive alternative to open anterior temporal lobectomy (ATL) [1]–[4] for mesial temporal lobe epilepsy (TLE) with improved cognitive outcomes [5]. The ongoing SLATE trial is investigating this treatment via a prospective multicenter design [6]. The discrepancy between effectiveness of SLAH versus ATL predicts that some patients will benefit from open resection following seizure recurrence after SLAH. Here we review the outcomes from ATL following SLAH in our institutional series.
Methods: We conducted an Institutional Review Board – approved retrospective review of all operative cases of SLAH from May 2012 to August 2019 at Emory University (Atlanta, GA, USA), looking for all patients that underwent subsequent ATL. Baseline demographic, outcome, and pathologic data were collected.
Results: Out of 99 SLAH patients, seizures recurred in 44 (44.4%) of whom 19 (19.2%) underwent a second intervention. Eleven (11.1%) underwent repeat and 1 attempted repeat SLAH. Eight (8.1%) underwent ATL (4 left, 4 right), including 2 after repeat SLAH. Intracranial monitoring with stereoelectroencephalography was performed in 3 patients prior to ATL. Baseline demographic data is summarized in Table 1.
Four patients (50%) achieved Engel I, 2 (25%) Engel II, and 2 (25%) Engel III outcome at 1 year following ATL. Both patients with worse outcome (IIIA) had EEG and PET features suggestive of bilateral temporal or multi-lobar pathology and/or non-localizing MRI findings. Pathological evaluation of resected samples, including ablative and peri-ablative regions, demonstrated evidence of reactive change in all patients (100%). Four patients (50%) had cortical samples suggestive of nodular neuronal heterotopia (i.e. focal cortical dysplasia), all of whom became Engel I or II. There were no complications from the ATL procedure. Outcome and pathological findings are summarized in Table 2.
Conclusions: Despite some technical nuances related to performing an open surgical resection following prior ablation, ATL is technically feasible, safe, and effective for achieving improved outcomes, including Engel I and II, in patients with prior SLAH. Possible predictors of conversion to ATL are reviewed. Pooling of longitudinal multicenter data will allow for better stratification of patients with TLE for SLAH, ATL, or conversion to ATL post-SLAH when necessary. Our experience also suggests that a staged approach to epilepsy surgery could be used to provide every opportunity to minimize cognitive and functional decline by starting with more minimally invasive options.
References
[1] J. T. Willie et al. Neurosurgery, vol. 74, no. 6, pp. 569–584, 2014.
[2] R. E. Gross et al. Ann. Neurol., 2018.
[3] C. Wu et al. Epilepsia, no. April, p. epi.15565, May 2019.
[4] K. Kohlhase et al. Epilepsia, vol. 62, no. 4, pp. 831–845, 2021.
[5] D. L. Drane et al. Epilepsia, vol. 56, no. 1, 2015.
[6] M. R. Sperling et al. Epilepsia, vol. 61, no. 6, pp. 1183–1189, Jun. 2020.
Funding: Please list any funding that was received in support of this abstract.: Royal College of Physicians and Surgeons of Canada Detweiler Travelling Fellowship.
Surgery