TY - JOUR
T1 - Piriform Cortex Ablation Volume Is Associated With Seizure Outcome in Mesial Temporal Lobe Epilepsy
AU - Hwang, Brian Y.
AU - Mampre, David
AU - Tsehay, Yohannes K.
AU - Negoita, Serban
AU - Kim, Min Jae
AU - Coogan, Christopher
AU - Eremiev, Alexander
AU - Palla, Adhith
AU - Weber-Levine, Carly
AU - Kang, Joon Y.
AU - Anderson, William S.
N1 - Publisher Copyright:
© 2022 Congress of Neurological Surgeons. All rights reserved.
PY - 2022/9/1
Y1 - 2022/9/1
N2 - BACKGROUND: Growing evidence suggests that piriform cortex resection during anterior temporal lobectomy is important for achieving good seizure outcome in mesial temporal lobe epilepsy (mTLE). However, the relationship between seizure outcome and piriform cortex ablation during MR-guided laser interstitial thermal therapy (MRgLITT) remains unclear. OBJECTIVE: To determine whether ablation of piriform cortex was associated with seizure outcome in patients with mTLE undergoing MRgLITT. METHODS: We performed preablation and postablation volumetric analyses of hippocampus, amygdala, piriform cortex, and ablation volumes in patients with mTLE who underwent MRgLITT at our institution from 2014 to 2019. RESULTS: Thirty nine patients with mTLE were analyzed. In univariate logistic regression, percent piriform cortex ablation was associated with International League Against Epilepsy (ILAE) class 1 at 6 months (odds ratio [OR] 1.051, 95% CI [1.001-1.117], P =.045), whereas ablation volume, percent amygdala ablation, and percent hippocampus ablation were not (P >.05). At 1 year, ablation volume was associated with ILAE class 1 (OR 1.608, 95% CI [1.071-2.571], P =.021) while percent piriform cortex ablation became a trend (OR 1.050, 95% CI [0.994-1.109], P =.054), and both percent hippocampus ablation and percent amygdala ablation were not significantly associated with ILAE class 1 (P >.05). In multivariable logistic regression, only percent piriform cortex ablation was a significant predictor of seizure freedom at 6 months (OR 1.085, 95% CI [1.012-1.193], P =.019) and at 1 year (OR 1.074, 95% CI [1.003-1.178], P =.041). CONCLUSION: Piriform cortex ablation volume is associated with seizure outcome in patients with mTLE undergoing MRgLITT. The piriform cortex should be considered a high yield ablation target to achieve good seizure outcome.
AB - BACKGROUND: Growing evidence suggests that piriform cortex resection during anterior temporal lobectomy is important for achieving good seizure outcome in mesial temporal lobe epilepsy (mTLE). However, the relationship between seizure outcome and piriform cortex ablation during MR-guided laser interstitial thermal therapy (MRgLITT) remains unclear. OBJECTIVE: To determine whether ablation of piriform cortex was associated with seizure outcome in patients with mTLE undergoing MRgLITT. METHODS: We performed preablation and postablation volumetric analyses of hippocampus, amygdala, piriform cortex, and ablation volumes in patients with mTLE who underwent MRgLITT at our institution from 2014 to 2019. RESULTS: Thirty nine patients with mTLE were analyzed. In univariate logistic regression, percent piriform cortex ablation was associated with International League Against Epilepsy (ILAE) class 1 at 6 months (odds ratio [OR] 1.051, 95% CI [1.001-1.117], P =.045), whereas ablation volume, percent amygdala ablation, and percent hippocampus ablation were not (P >.05). At 1 year, ablation volume was associated with ILAE class 1 (OR 1.608, 95% CI [1.071-2.571], P =.021) while percent piriform cortex ablation became a trend (OR 1.050, 95% CI [0.994-1.109], P =.054), and both percent hippocampus ablation and percent amygdala ablation were not significantly associated with ILAE class 1 (P >.05). In multivariable logistic regression, only percent piriform cortex ablation was a significant predictor of seizure freedom at 6 months (OR 1.085, 95% CI [1.012-1.193], P =.019) and at 1 year (OR 1.074, 95% CI [1.003-1.178], P =.041). CONCLUSION: Piriform cortex ablation volume is associated with seizure outcome in patients with mTLE undergoing MRgLITT. The piriform cortex should be considered a high yield ablation target to achieve good seizure outcome.
KW - Ablation
KW - MR-guided laser interstitial thermal therapy
KW - Mesial temporal lobe epilepsy
KW - Piriform
KW - Volume
UR - http://www.scopus.com/inward/record.url?scp=85135599056&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85135599056&partnerID=8YFLogxK
U2 - 10.1227/neu.0000000000002041
DO - 10.1227/neu.0000000000002041
M3 - Article
C2 - 35593730
AN - SCOPUS:85135599056
SN - 0148-396X
VL - 91
SP - 414
EP - 421
JO - Neurosurgery
JF - Neurosurgery
IS - 3
ER -