Transfrontal Approach to the Amygdala for Ablation With Laser Interstitial Thermal Therapy: An Epilepsy Case Report.
Oper Neurosurg (Hagerstown)
; 24(5): e381-e384, 2023 05 01.
Article
in En
| MEDLINE
| ID: mdl-36715982
ABSTRACT
BACKGROUND AND IMPORTANCE Stereotactic laser amygdalohippocampotomy (SLAH) using laser interstitial thermal therapy is a minimally invasive surgery used to treat mesial temporal lobe epilepsy. It uses laser probes inserted through occipital and temporo-occipital trajectories to ablate the hippocampus and amygdala. However, these trajectories are limited in their ability to ablate the superior amygdala and entorhinal cortex (ERC). We present a trajectory through the middle frontal gyrus as an alternative to the temporo-occipital trajectory, which provides more complete ablation of the amygdala and anterior ERC through a single pass. CLINICAL PRESENTATION A 70-year-old woman with seizures characterized by fear were localized to the left superomedial amygdala on intracranial electroencephalography. They developed after resection of a left temporal arteriovenous malformation and were refractory to medication. Her age and prior craniotomy made open resection less desirable. A frontal and occipital SLAH achieved Engel 1a at 1-year follow-up without decline in neuropsychological performance scores. CONCLUSION:
Typical SLAH uses trajectories that have limited ability to ablate the superior and medial amygdala and ERC in a single passage. A combined approach using an occipital and frontal trajectory allows more complete ablation of the amygdala, hippocampus, and ERC.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Epilepsy, Temporal Lobe
/
Laser Therapy
Limits:
Aged
/
Female
/
Humans
Language:
En
Journal:
Oper Neurosurg (Hagerstown)
Year:
2023
Document type:
Article