研究目的
To provide a review of cognitive outcomes across a full neuropsychological profile in patients who underwent laser interstitial thermal therapy (LiTT) for mesiotemporal epilepsy (mTLE).
研究成果
Cognitive changes following LiTT for the treatment of intractable MTS can occur in both memory and nonmemory domains. Cognitive performance improved in patients who underwent both dominant and nondominant hemisphere procedures, but with greater frequency in the nondominant group. In comparison to the outcome literature of dominant open ATL resections, our LiTT case series exhibited a much lower incidence of postoperative language or verbal memory decline. Normal presurgical cognitive performance represented a risk factor for clinically significant decline following LiTT.
研究不足
Selection bias for severely intractable cases of epilepsy and variability in the presence of MTS, the sample is generally consistent with the population of persons seeking surgical treatment for epilepsy.
1:Experimental Design and Method Selection:
Retrospective review of clinical and neuropsychological data was approved by the University of Miami (UM), Institutional Review Board (IRB). Written informed consent from patients or guardians was not required, as this was a retrospective analysis of deidentified data from a medical record repository designed specifically for use by the Comprehensive Epilepsy Center at the UM.
2:Sample Selection and Data Sources:
A total of 29 patients underwent LiTT for medically refractory focal epilepsy of mesial temporal origin at the UM Comprehensive Epilepsy Center, a level 4 epilepsy-accredited facility. Participants were seen consecutively between 2013 and
3:List of Experimental Equipment and Materials:
20 All LiTT procedures were performed by a single surgeon at the UM Hospital. After receiving general anesthesia, patients had a stereotactic frame placed (CRW, Plainsboro, NJ) and underwent thin-cut CT, which was then merged with the preoperative seizure protocol MRI using Medtronic (Minneapolis, MN) Stealth navigation to obtain frame-based coordinates for amygdala and hippocampus.
4:Experimental Procedures and Operational Workflow:
After an occipital craniostomy and insertion of the laser in the operating room, patients were transported to the MRI suite for thermal imaging, which involved 3–5 serial ablations along the occipital trajectory.
5:Data Analysis Methods:
Change in cognitive performance following LiTT was assessed from a clinical perspective by reviewing each participant’s profile individually to identify areas where a ±1SD change occurred and whether this change (>1SD) resulted in reclassification of performance from within normal limits to a clinically impaired range or vice versa.
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