title: Laser thermal ablation for mesiotemporal epilepsy: Analysis of ablation volumes and trajectories.
abstract: To identify features of ablations and trajectories that correlate with optimal seizure control and minimize the risk of neurocognitive deficits in patients undergoing laser interstitial thermal therapy (LiTT) for mesiotemporal epilepsy (mTLE).
  
  
  
  Clinical and radiographic data were reviewed from a prospectively maintained database of all patients undergoing LiTT for the treatment of mTLE at the University of Miami Hospital. Standard preoperative and postoperative evaluations, including contrast-enhanced magnetic resonance imaging (MRI) and neuropsychological testing, were performed in all patients. Laser trajectory and ablation volumes were computed both by manual tracing of mesiotemporal structures and by nonrigid registration of ablation cavities to a common reference system based on 7T MRI data.
  
  
  
  Among 23 patients with at least 1-year follow-up, 15 (65%) were free of disabling seizures since the time of their surgery. Sparing of the mesial hippocampal head was significantly correlated with persistent disabling seizures (p = 0.01). A lateral trajectory through the hippocampus showed a trend for poor seizure outcome (p = 0.08). A comparison of baseline and postoperative neurocognitive testing revealed areas of both improvement and worsening, which were not associated with ablation volume or trajectory.
  
  
  
  At 1-year follow-up, LiTT appears to be a safe and effective tool for the treatment of mTLE, although a longer follow-up period is necessary to confirm these observations. Better understanding of the impact of ablation volume and location could potentially fine-tune this technique to improve seizure-freedom rates and associated neurologic and cognitive changes.
authors.affiliation: Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, Florida, U.S.A.
authors.forename: Walter J
authors.initials: WJ
authors.lastname: Jermakowicz
authors.affiliation: Epilepsy Division, Department of Neurology, Miller School of Medicine, University of Miami, Miami, Florida, U.S.A.
authors.forename: Andres M
authors.initials: AM
authors.lastname: Kanner
authors.affiliation: Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, Florida, U.S.A.
authors.forename: Samir
authors.initials: S
authors.lastname: Sur
authors.affiliation: Division of Neuropsychology, Department of Neurology, Miller School of Medicine, University of Miami, Miami, Florida, U.S.A.
authors.forename: Christina
authors.initials: C
authors.lastname: Bermudez
authors.affiliation: Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, Tennessee, U.S.A.
authors.forename: Pierre-Francois
authors.initials: PF
authors.lastname: D'Haese
authors.affiliation: Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, Florida, U.S.A.
authors.forename: John Paul G
authors.initials: JPG
authors.lastname: Kolcun
authors.affiliation: Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, Florida, U.S.A.
authors.forename: Iahn
authors.initials: I
authors.lastname: Cajigas
authors.affiliation: Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, Tennessee, U.S.A.
authors.forename: Rui
authors.initials: R
authors.lastname: Li
authors.affiliation: Epilepsy Division, Department of Neurology, Miller School of Medicine, University of Miami, Miami, Florida, U.S.A.
authors.forename: Carlos
authors.initials: C
authors.lastname: Millan
authors.affiliation: Epilepsy Division, Department of Neurology, Miller School of Medicine, University of Miami, Miami, Florida, U.S.A.
authors.forename: Ramses
authors.initials: R
authors.lastname: Ribot
authors.affiliation: Epilepsy Division, Department of Neurology, Miller School of Medicine, University of Miami, Miami, Florida, U.S.A.
authors.forename: Enrique A
authors.initials: EA
authors.lastname: Serrano
authors.affiliation: Epilepsy Division, Department of Neurology, Miller School of Medicine, University of Miami, Miami, Florida, U.S.A.
authors.forename: Naymee
authors.initials: N
authors.lastname: Velez
authors.affiliation: Epilepsy Division, Department of Neurology, Miller School of Medicine, University of Miami, Miami, Florida, U.S.A.
authors.forename: Merredith R
authors.initials: MR
authors.lastname: Lowe
authors.affiliation: Division of Neuropsychology, Department of Neurology, Miller School of Medicine, University of Miami, Miami, Florida, U.S.A.
authors.forename: Gustavo J
authors.initials: GJ
authors.lastname: Rey
authors.affiliation: Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, Florida, U.S.A.
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Jagid
mesh_terms: D000328:Adult; D000679:Amygdala / Q000601:surgery; D038481:Anterior Temporal Lobectomy / Q000009:adverse effects / Q000379:methods*; D001931:Brain Mapping; D004833:Epilepsy, Temporal Lobe / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006624:Hippocampus / Q000601:surgery; D006801:Humans; D053685:Laser Therapy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019965:Neurocognitive Disorders / Q000517:prevention & control*; D009483:Neuropsychological Tests; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies; D012307:Risk Factors; D013223:Statistics as Topic
keywords: Amygdala; Deformable atlas; Hippocampus; Memory; Volumetric analysis