MRI-Guided stereotactic laser ablation for epilepsy surgery: Promising preliminary results for cognitive outcome

Abstract

Cognitive outcome data are reviewed with respect to the use of magnetic-resonance guided stereotactic laser ablation (SLA) as an epilepsy surgical procedure, with comparisons drawn to traditional open resection procedures. Cognitive outcome with stereotactic laser amygdalohippocampotomy (SLAH) appears better than open resection for several functions dependent on extra-mesial temporal lobe (TL) structures, including category-related naming, verbal fluency, and object/familiar person recognition. Preliminary data suggests episodic, declarative verbal memory can decline following SLAH in the language dominant hemisphere, although early findings suggest comparable or even superior outcomes compared with open resection. The hippocampus has long been considered a central structure supporting episodic, declarative memory, with epilepsy surgical teams attempting to spare it whenever possible. However, ample data from animal and human neuroscience research suggests declarative memory deficits are greater following broader mesial TL lesions that include parahippocampal gyrus and lateral TL inputs. Therefore, employing a neurosurgical technique that restricts the surgical lesion zone holds promise for achieving a better cognitive outcome. Focal SLA lesions outside of the amygdalohippocampal complex may impair select cognitive functions, although few data have been published in such patients to date. SLA is being effectively employed with adults and children with TL or lesional epilepsies across several U.S. epilepsy centers, which may simultaneously optimize cognitive outcome while providing a curative treatment for seizures.

Keywords: Cognitive outcome; Epilepsy surgery; LITT; Laser interstitial thermal therapy; Memory; Naming.

Figure 1

Depiction of the Optical Fiber, the Ablation Process, and Pre- and Post-Ablation MRI Images in an Axial Plane Demonstrating the Focal Nature of the Damage Zone.

Figure 2

Histograms showing individual level performance change by type of surgery: a) Change in BNT raw score for dominant temporal lobe cases by surgery type; b) Change in Famous Face naming performance on modified Iowa Famous Faces Test for dominant temporal lobe cases by surgery type; c) Change in Famous Face recognition performance on modified Iowa Famous Faces Test for nondominant temporal lobe cases by surgery type. Note. SLAH = stereotactic laser amygdalohippocampotomy; BNT = Boston Naming Test; TL = Temporal Lobe. Reprinted from Drane DL, Loring DW, Voets NL, et al. Better object recognition and naming outcome with MRI-guided stereotactic laser amygdalohippocampotomy for temporal lobe epilepsy. Epilepsia 2015;56:101-113.

Figure 2

Histograms showing individual level performance change by type of surgery: a) Change in BNT raw score for dominant temporal lobe cases by surgery type; b) Change in Famous Face naming performance on modified Iowa Famous Faces Test for dominant temporal lobe cases by surgery type; c) Change in Famous Face recognition performance on modified Iowa Famous Faces Test for nondominant temporal lobe cases by surgery type. Note. SLAH = stereotactic laser amygdalohippocampotomy; BNT = Boston Naming Test; TL = Temporal Lobe. Reprinted from Drane DL, Loring DW, Voets NL, et al. Better object recognition and naming outcome with MRI-guided stereotactic laser amygdalohippocampotomy for temporal lobe epilepsy. Epilepsia 2015;56:101-113.

Figure 2

Histograms showing individual level performance change by type of surgery: a) Change in BNT raw score for dominant temporal lobe cases by surgery type; b) Change in Famous Face naming performance on modified Iowa Famous Faces Test for dominant temporal lobe cases by surgery type; c) Change in Famous Face recognition performance on modified Iowa Famous Faces Test for nondominant temporal lobe cases by surgery type. Note. SLAH = stereotactic laser amygdalohippocampotomy; BNT = Boston Naming Test; TL = Temporal Lobe. Reprinted from Drane DL, Loring DW, Voets NL, et al. Better object recognition and naming outcome with MRI-guided stereotactic laser amygdalohippocampotomy for temporal lobe epilepsy. Epilepsia 2015;56:101-113.