• Jon Timothy Willie and Robert E Gross.
• Neurosurgery. 2015 Aug 1;62 Suppl 1:233-4.

IntroductionMRI-guided stereotactic laser amygdalohippocampotomy (SLAH) is a minimally invasive and effective alternative to open temporal lobe surgery in appropriately selected patients. We have previously demonstrated SLAH to be most effective for patients with mesial temporal sclerosis (MTS) on preoperative MRI. Nevertheless, patients who do not achieve seizure freedom may benefit from additional procedures. The feasibility, safety, and efficacy of repeat laser ablation of remaining mesial temporal structures have not been reported.MethodsA prospective cohort of 41 patients with mesial temporal lobe epilepsy, including patients with and without MTS, underwent SLAH at our institution. Patients that did not maintain seizure freedom underwent repeat MRI to reevaluate extent of ablation. Of these, 5 subjects (3 with and 2 without preoperative MTS) underwent a second procedure extending the ablation of extrahippocampal mesial temporal structures (eg, amygdala, entorhinal cortex, parahippocampal gyrus) and underwent routine clinical follow up.ResultsExtended extrahippocampal temporal lobe ablations were performed from posterior temporal/occipital trajectories with 1 to 3 independent trajectories. Repeat procedures were well tolerated, there were no significant hemorrhages or other complications, and all patients were discharged within 1 to 2 days. At mean follow up of 6.2 (median 4, range 2-12) months, all 5 subjects were seizure free following extended ablation.ConclusionWhile SLAH alone is effective for select patients with mesial temporal lobe epilepsy, this preliminary study indicates that additional extended ablation of extrahippocampal mesial temporal structures may provide additional relief from recurrent seizures. Additional subjects, longer outcomes, and neurocognitive assessments are pending.

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