Effects of surgical targeting in laser interstitial thermal therapy for mesial temporal lobe epilepsy

A multicenter study of 234 patients

Chengyuan Wu, Walter J. Jermakowicz, Srijata Chakravorti, Iahn Cajigas, Ashwini D. Sharan, Jonathan R. Jagid, Caio M. Matias, Michael R. Sperling, Robert Buckley, Andrew Ko, Jeffrey G. Ojemann, John W. Miller, Brett Youngerman, Sameer A. Sheth, Guy M. McKhann, Adrian W. Laxton, Daniel E. Couture, Gautam S. Popli, Alexander Smith, Ashesh D. Mehta & 12 others Allen L. Ho, Casey H. Halpern, Dario J. Englot, Joseph S. Neimat, Peter E. Konrad, Elliot Neal, Fernando Vale Diaz, Kathryn L. Holloway, Ellen L. Air, Jason Schwalb, Benoit M. Dawant, Pierre Francois D'Haese

Research output: Contribution to journalArticle

Abstract

Objective: Laser interstitial thermal therapy (LITT) for mesial temporal lobe epilepsy (mTLE) has reported seizure freedom rates between 36% and 78% with at least 1 year of follow-up. Unfortunately, the lack of robust methods capable of incorporating the inherent variability of patient anatomy, the variability of the ablated volumes, and clinical outcomes have limited three-dimensional quantitative analysis of surgical targeting and its impact on seizure outcomes. We therefore aimed to leverage a novel image-based methodology for normalizing surgical therapies across a large multicenter cohort to quantify the effects of surgical targeting on seizure outcomes in LITT for mTLE. Methods: This multicenter, retrospective cohort study included 234 patients from 11 centers who underwent LITT for mTLE. To investigate therapy location, all ablation cavities were manually traced on postoperative magnetic resonance imaging (MRI), which were subsequently nonlinearly normalized to a common atlas space. The association of clinical variables and ablation location to seizure outcome was calculated using multivariate regression and Bayesian models, respectively. Results: Ablations including more anterior, medial, and inferior temporal lobe structures, which involved greater amygdalar volume, were more likely to be associated with Engel class I outcomes. At both 1 and 2 years after LITT, 58.0% achieved Engel I outcomes. A history of bilateral tonic-clonic seizures decreased chances of Engel I outcome. Radiographic hippocampal sclerosis was not associated with seizure outcome. Significance: LITT is a viable treatment for mTLE in patients who have been properly evaluated at a comprehensive epilepsy center. Consideration of surgical factors is imperative to the complete assessment of LITT. Based on our model, ablations must prioritize the amygdala and also include the hippocampal head, parahippocampal gyrus, and rhinal cortices to maximize chances of seizure freedom. Extending the ablation posteriorly has diminishing returns. Further work is necessary to refine this analysis and define the minimal zone of ablation necessary for seizure control.

Original languageEnglish (US)
Pages (from-to)1171-1183
Number of pages13
JournalEpilepsia
Volume60
Issue number6
DOIs
StatePublished - Jun 1 2019

Fingerprint

Temporal Lobe Epilepsy
Multicenter Studies
Lasers
Hot Temperature
Seizures
Therapeutics
Post-Traumatic Epilepsy
Parahippocampal Gyrus
Atlases
Sclerosis
Temporal Lobe
Amygdala
Nose
Epilepsy
Anatomy
Cohort Studies
Retrospective Studies
Head
Magnetic Resonance Imaging

Keywords

  • MRI
  • ablation
  • amygdalohippocampectomy
  • stereotactic
  • surgery

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

Cite this

Wu, C., Jermakowicz, W. J., Chakravorti, S., Cajigas, I., Sharan, A. D., Jagid, J. R., ... D'Haese, P. F. (2019). Effects of surgical targeting in laser interstitial thermal therapy for mesial temporal lobe epilepsy: A multicenter study of 234 patients. Epilepsia, 60(6), 1171-1183. https://doi.org/10.1111/epi.15565

Effects of surgical targeting in laser interstitial thermal therapy for mesial temporal lobe epilepsy : A multicenter study of 234 patients. / Wu, Chengyuan; Jermakowicz, Walter J.; Chakravorti, Srijata; Cajigas, Iahn; Sharan, Ashwini D.; Jagid, Jonathan R.; Matias, Caio M.; Sperling, Michael R.; Buckley, Robert; Ko, Andrew; Ojemann, Jeffrey G.; Miller, John W.; Youngerman, Brett; Sheth, Sameer A.; McKhann, Guy M.; Laxton, Adrian W.; Couture, Daniel E.; Popli, Gautam S.; Smith, Alexander; Mehta, Ashesh D.; Ho, Allen L.; Halpern, Casey H.; Englot, Dario J.; Neimat, Joseph S.; Konrad, Peter E.; Neal, Elliot; Vale Diaz, Fernando; Holloway, Kathryn L.; Air, Ellen L.; Schwalb, Jason; Dawant, Benoit M.; D'Haese, Pierre Francois.

In: Epilepsia, Vol. 60, No. 6, 01.06.2019, p. 1171-1183.

Research output: Contribution to journalArticle

Wu, C, Jermakowicz, WJ, Chakravorti, S, Cajigas, I, Sharan, AD, Jagid, JR, Matias, CM, Sperling, MR, Buckley, R, Ko, A, Ojemann, JG, Miller, JW, Youngerman, B, Sheth, SA, McKhann, GM, Laxton, AW, Couture, DE, Popli, GS, Smith, A, Mehta, AD, Ho, AL, Halpern, CH, Englot, DJ, Neimat, JS, Konrad, PE, Neal, E, Vale Diaz, F, Holloway, KL, Air, EL, Schwalb, J, Dawant, BM & D'Haese, PF 2019, 'Effects of surgical targeting in laser interstitial thermal therapy for mesial temporal lobe epilepsy: A multicenter study of 234 patients', Epilepsia, vol. 60, no. 6, pp. 1171-1183. https://doi.org/10.1111/epi.15565
Wu, Chengyuan ; Jermakowicz, Walter J. ; Chakravorti, Srijata ; Cajigas, Iahn ; Sharan, Ashwini D. ; Jagid, Jonathan R. ; Matias, Caio M. ; Sperling, Michael R. ; Buckley, Robert ; Ko, Andrew ; Ojemann, Jeffrey G. ; Miller, John W. ; Youngerman, Brett ; Sheth, Sameer A. ; McKhann, Guy M. ; Laxton, Adrian W. ; Couture, Daniel E. ; Popli, Gautam S. ; Smith, Alexander ; Mehta, Ashesh D. ; Ho, Allen L. ; Halpern, Casey H. ; Englot, Dario J. ; Neimat, Joseph S. ; Konrad, Peter E. ; Neal, Elliot ; Vale Diaz, Fernando ; Holloway, Kathryn L. ; Air, Ellen L. ; Schwalb, Jason ; Dawant, Benoit M. ; D'Haese, Pierre Francois. / Effects of surgical targeting in laser interstitial thermal therapy for mesial temporal lobe epilepsy : A multicenter study of 234 patients. In: Epilepsia. 2019 ; Vol. 60, No. 6. pp. 1171-1183.
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title = "Effects of surgical targeting in laser interstitial thermal therapy for mesial temporal lobe epilepsy: A multicenter study of 234 patients",
abstract = "Objective: Laser interstitial thermal therapy (LITT) for mesial temporal lobe epilepsy (mTLE) has reported seizure freedom rates between 36{\%} and 78{\%} with at least 1 year of follow-up. Unfortunately, the lack of robust methods capable of incorporating the inherent variability of patient anatomy, the variability of the ablated volumes, and clinical outcomes have limited three-dimensional quantitative analysis of surgical targeting and its impact on seizure outcomes. We therefore aimed to leverage a novel image-based methodology for normalizing surgical therapies across a large multicenter cohort to quantify the effects of surgical targeting on seizure outcomes in LITT for mTLE. Methods: This multicenter, retrospective cohort study included 234 patients from 11 centers who underwent LITT for mTLE. To investigate therapy location, all ablation cavities were manually traced on postoperative magnetic resonance imaging (MRI), which were subsequently nonlinearly normalized to a common atlas space. The association of clinical variables and ablation location to seizure outcome was calculated using multivariate regression and Bayesian models, respectively. Results: Ablations including more anterior, medial, and inferior temporal lobe structures, which involved greater amygdalar volume, were more likely to be associated with Engel class I outcomes. At both 1 and 2 years after LITT, 58.0{\%} achieved Engel I outcomes. A history of bilateral tonic-clonic seizures decreased chances of Engel I outcome. Radiographic hippocampal sclerosis was not associated with seizure outcome. Significance: LITT is a viable treatment for mTLE in patients who have been properly evaluated at a comprehensive epilepsy center. Consideration of surgical factors is imperative to the complete assessment of LITT. Based on our model, ablations must prioritize the amygdala and also include the hippocampal head, parahippocampal gyrus, and rhinal cortices to maximize chances of seizure freedom. Extending the ablation posteriorly has diminishing returns. Further work is necessary to refine this analysis and define the minimal zone of ablation necessary for seizure control.",
keywords = "MRI, ablation, amygdalohippocampectomy, stereotactic, surgery",
author = "Chengyuan Wu and Jermakowicz, {Walter J.} and Srijata Chakravorti and Iahn Cajigas and Sharan, {Ashwini D.} and Jagid, {Jonathan R.} and Matias, {Caio M.} and Sperling, {Michael R.} and Robert Buckley and Andrew Ko and Ojemann, {Jeffrey G.} and Miller, {John W.} and Brett Youngerman and Sheth, {Sameer A.} and McKhann, {Guy M.} and Laxton, {Adrian W.} and Couture, {Daniel E.} and Popli, {Gautam S.} and Alexander Smith and Mehta, {Ashesh D.} and Ho, {Allen L.} and Halpern, {Casey H.} and Englot, {Dario J.} and Neimat, {Joseph S.} and Konrad, {Peter E.} and Elliot Neal and {Vale Diaz}, Fernando and Holloway, {Kathryn L.} and Air, {Ellen L.} and Jason Schwalb and Dawant, {Benoit M.} and D'Haese, {Pierre Francois}",
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doi = "10.1111/epi.15565",
language = "English (US)",
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pages = "1171--1183",
journal = "Epilepsia",
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TY - JOUR

T1 - Effects of surgical targeting in laser interstitial thermal therapy for mesial temporal lobe epilepsy

T2 - A multicenter study of 234 patients

AU - Wu, Chengyuan

AU - Jermakowicz, Walter J.

AU - Chakravorti, Srijata

AU - Cajigas, Iahn

AU - Sharan, Ashwini D.

AU - Jagid, Jonathan R.

AU - Matias, Caio M.

AU - Sperling, Michael R.

AU - Buckley, Robert

AU - Ko, Andrew

AU - Ojemann, Jeffrey G.

AU - Miller, John W.

AU - Youngerman, Brett

AU - Sheth, Sameer A.

AU - McKhann, Guy M.

AU - Laxton, Adrian W.

AU - Couture, Daniel E.

AU - Popli, Gautam S.

AU - Smith, Alexander

AU - Mehta, Ashesh D.

AU - Ho, Allen L.

AU - Halpern, Casey H.

AU - Englot, Dario J.

AU - Neimat, Joseph S.

AU - Konrad, Peter E.

AU - Neal, Elliot

AU - Vale Diaz, Fernando

AU - Holloway, Kathryn L.

AU - Air, Ellen L.

AU - Schwalb, Jason

AU - Dawant, Benoit M.

AU - D'Haese, Pierre Francois

PY - 2019/6/1

Y1 - 2019/6/1

N2 - Objective: Laser interstitial thermal therapy (LITT) for mesial temporal lobe epilepsy (mTLE) has reported seizure freedom rates between 36% and 78% with at least 1 year of follow-up. Unfortunately, the lack of robust methods capable of incorporating the inherent variability of patient anatomy, the variability of the ablated volumes, and clinical outcomes have limited three-dimensional quantitative analysis of surgical targeting and its impact on seizure outcomes. We therefore aimed to leverage a novel image-based methodology for normalizing surgical therapies across a large multicenter cohort to quantify the effects of surgical targeting on seizure outcomes in LITT for mTLE. Methods: This multicenter, retrospective cohort study included 234 patients from 11 centers who underwent LITT for mTLE. To investigate therapy location, all ablation cavities were manually traced on postoperative magnetic resonance imaging (MRI), which were subsequently nonlinearly normalized to a common atlas space. The association of clinical variables and ablation location to seizure outcome was calculated using multivariate regression and Bayesian models, respectively. Results: Ablations including more anterior, medial, and inferior temporal lobe structures, which involved greater amygdalar volume, were more likely to be associated with Engel class I outcomes. At both 1 and 2 years after LITT, 58.0% achieved Engel I outcomes. A history of bilateral tonic-clonic seizures decreased chances of Engel I outcome. Radiographic hippocampal sclerosis was not associated with seizure outcome. Significance: LITT is a viable treatment for mTLE in patients who have been properly evaluated at a comprehensive epilepsy center. Consideration of surgical factors is imperative to the complete assessment of LITT. Based on our model, ablations must prioritize the amygdala and also include the hippocampal head, parahippocampal gyrus, and rhinal cortices to maximize chances of seizure freedom. Extending the ablation posteriorly has diminishing returns. Further work is necessary to refine this analysis and define the minimal zone of ablation necessary for seizure control.

AB - Objective: Laser interstitial thermal therapy (LITT) for mesial temporal lobe epilepsy (mTLE) has reported seizure freedom rates between 36% and 78% with at least 1 year of follow-up. Unfortunately, the lack of robust methods capable of incorporating the inherent variability of patient anatomy, the variability of the ablated volumes, and clinical outcomes have limited three-dimensional quantitative analysis of surgical targeting and its impact on seizure outcomes. We therefore aimed to leverage a novel image-based methodology for normalizing surgical therapies across a large multicenter cohort to quantify the effects of surgical targeting on seizure outcomes in LITT for mTLE. Methods: This multicenter, retrospective cohort study included 234 patients from 11 centers who underwent LITT for mTLE. To investigate therapy location, all ablation cavities were manually traced on postoperative magnetic resonance imaging (MRI), which were subsequently nonlinearly normalized to a common atlas space. The association of clinical variables and ablation location to seizure outcome was calculated using multivariate regression and Bayesian models, respectively. Results: Ablations including more anterior, medial, and inferior temporal lobe structures, which involved greater amygdalar volume, were more likely to be associated with Engel class I outcomes. At both 1 and 2 years after LITT, 58.0% achieved Engel I outcomes. A history of bilateral tonic-clonic seizures decreased chances of Engel I outcome. Radiographic hippocampal sclerosis was not associated with seizure outcome. Significance: LITT is a viable treatment for mTLE in patients who have been properly evaluated at a comprehensive epilepsy center. Consideration of surgical factors is imperative to the complete assessment of LITT. Based on our model, ablations must prioritize the amygdala and also include the hippocampal head, parahippocampal gyrus, and rhinal cortices to maximize chances of seizure freedom. Extending the ablation posteriorly has diminishing returns. Further work is necessary to refine this analysis and define the minimal zone of ablation necessary for seizure control.

KW - MRI

KW - ablation

KW - amygdalohippocampectomy

KW - stereotactic

KW - surgery

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