Introduction: As a novel, minimally invasive surgical technique, laser ablation of epileptogenic foci has become an alternative to open surgery for patients with mesial temporal lobe epilepsy (MTLE). Visual field defects (VFDs) are reported to occur in 52–100% of patients following open surgery for MTLE. However, the rate of VFD following laser ablation amygdalo-hippocampectomy (AHE) in patients with MTLE is unknown.
Methods: We performed a retrospective case series of 3 consecutive patients who underwent laser interstitial thermal therapy (LITT) AHE, for medically refractory MTLE between June and December 2015. Follow-up included assessment of seizure outcome and VFDs.
Results: All 3 patients underwent formal visual field testing at 3 months postoperatively (1 male; 2 female). The mean age was 53.3 years (range 28 - 69 years). All 3 patients had preoperative video EEG, MRI, fMRI, DTI and tractography, PET, Wada test and neuropsychological evaluation. During follow-up ranging from 5 - 7 (median 5.7) months, all patients achieved significant seizure reduction, and one patient was seizure free. Postoperatively, no patient reported subjective visual changes or had detectable VFDs based on bedside confrontation testing. Formal visual field testing was normal in these three patients. No other complications or neuropsychological side effects related to laser ablation were noted.
Conclusions: Short-term follow-up in our series suggests that laser ablation AHE is associated with a lower rate of VFD. Interestingly, it did not cause VFDs in any of our patients. A larger series, with longer follow-up is being acquired, and is necessary to assess the robustness of this finding.
Patient Care: Improve clinical outcomes in patients with mesial temporal lobe epilepsy by improving surgical techniques related to laser-ablation amygdalo-hippocampectomy.
Learning Objectives: Relation between visual field defects and laser-ablation amygdalo-hippocampectomy in patients with mesial temporal lobe epilepsy.