The Surgical Learning Curve for Successful Stereotactic Laser Amygdalohippocamptomy and Surgical Rescue of Failures
Abstract number :
2.421
Submission category :
9. Surgery / 9A. Adult
Year :
2024
Submission ID :
1240
Source :
www.aesnet.org
Presentation date :
12/8/2024 12:00:00 AM
Published date :
Authors :
Presenting Author: Jonathan Lau, MD, PhD, FRCSC – Western University, London Ontario Canada
Ashley Raghu, MB ChB DPhil – Emory University
Matthew Stern, BS – Emory University
Faical Isbaine, PhD – Emory University
Dayton Grogan, MD – University of Virginia
Rebecca Roth, BA – Emory University
Adam Dickey, MD, PhD – Emory University
Jon Willie, MD PhD – Department of Neurosurgery, Washington University in St. Louis
Daniel Drane, PhD – Emory University
Robert Gross, MD, PhD – Rutgers New Jersey Medical School
Rationale: Stereotactic laser amygdalohippocampotomy (SLAH) is a minimally invasive procedure for mesial temporal lobe epilepsy that preserves more tissue than open procedures, resulting in more patients - approximately half - not achieving seizure freedom, but with improved functional outcomes, and the possibility of further surgery as needed. A lucid framework for managing these patients is needed that accounts for the nature and the likelihood of the risks and benefits that further procedures confer.
Methods: We retrospectively reviewed a continuous series (2011-2019) of SLAH operations at our institution to determine trends in management, identifying cases where further surgery was performed. Pre-operative and follow-up seizure, cognitive, functional data and surgical complications were collated.
Results: Of 108 patients undergoing primary SLAH, 21 (19%) underwent further surgery (23 procedures). Stereoelectroencephalography informed 7 procedures (30%). There was a trend for quicker SLAH failure in the earlier patients and 82% of repeat surgeries were carried out in the earliest quartile of patients. At 1-year follow up, six of twelve patients (50%) achieved seizure freedom after repeat SLAH and five of eight patients (63%) achieved seizure freedom after ATL, one of which was after two failed SLAHs. Two of three patients undergoing an ablation outside the mesial temporal lobe achieved seizure freedom at 1-year. Neuropsychological sequelae were more prevalent with ATL than SLAH, including decline in visual naming (p=0.01) and functional status (p< 0.05).
Conclusions: Repeat SLAH and ATL post-SLAH are both practicable and can be effective.
Surgical experience, risk to cognition, and marginal benefit relative to existing improvement are principal considerations for further surgery.
Funding: None
Surgery