title: MRI-guided laser interstitial thermal therapy for treatment of medically refractory non-lesional mesial temporal lobe epilepsy: Outcomes, complications, and current limitations: A review.
abstract: There is a new focus on minimally invasive treatments for medically refractory mesial temporal lobe epilepsy (MTLE). MRI-guided laser interstitial thermal therapy (MRgLITT) is one such minimally invasive procedure, which utilizes MRI guidance and real-time feedback to ablate an epileptogenic focus. A total of 38 patients presenting exclusively with MTLE and no other lesions (including neoplasia), who underwent MRgLITT were reviewed. We evaluated a number of outcome measures, including seizure freedom, neuropsychological performance, complications, and other considerations. Eighteen (53%) had an Engel class I outcome, 10 patients had repeat procedures/operations, and 12 post-procedural complications occurred. Follow-up time ranged from 6 to 38.5months. There was a decreased length of procedure time, hospitalization time, and analgesic requirement when compared to open surgery. In cases of well-localized MTLE this procedure may offer similar (albeit slightly lower) rates of seizure freedom versus traditional surgery. MRgLITT may be an alternative treatment option for high risk surgical patients and, more importantly, could increase referrals for surgery in patients with medically refractory MTLE. However, data is limited and long-term outcomes have not been evaluated. Further investigation is required to understand the potential of this minimally invasive technique for MTLE.
authors.affiliation: Department of Neurosurgery and Brain Repair, Morsani College of Medicine, University of South Florida, 2 Tampa General Circle, USF Health, 7th Floor, Tampa, FL 33606, USA; Department of Neurology, Dartmouth Hitchcock Medical Center, 1 Medical Center Dr. Lebanon, NH 03766, USA. Electronic address: hena.waseem@hitchcock.org.
authors.forename: Hena
authors.initials: H
authors.lastname: Waseem
authors.affiliation: Department of Neurosurgery and Brain Repair, Morsani College of Medicine, University of South Florida, 2 Tampa General Circle, USF Health, 7th Floor, Tampa, FL 33606, USA. Electronic address: avivas1@health.usf.edu.
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Vivas
authors.affiliation: Department of Neurosurgery and Brain Repair, Morsani College of Medicine, University of South Florida, 2 Tampa General Circle, USF Health, 7th Floor, Tampa, FL 33606, USA. Electronic address: fvale@health.usf.edu.
authors.forename: Fernando L
authors.initials: FL
authors.lastname: Vale
mesh_terms: D000069279:Drug Resistant Epilepsy / Q000628:therapy*; D004833:Epilepsy, Temporal Lobe / Q000628:therapy*; D006801:Humans; D006979:Hyperthermia, Induced / Q000379:methods*; D053685:Laser Therapy / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D019635:Neurosurgical Procedures / Q000379:methods*; D010043:Outcome and Process Assessment, Health Care; D025321:Surgery, Computer-Assisted / Q000379:methods*
keywords: Laser ablation; MRI guided laser interstitial thermal therapy; Medically refractory epilepsy; Mesial temporal lobe epilepsy; Mesial temporal sclerosis; Seizure