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Anatomic and Thermometric Analysis of Cranial Nerve Palsy after Laser Amygdalohippocampotomy for Mesial Temporal Lobe Epilepsy.

Publication ,  Journal Article
Huang, Y; Leung, SA; Parker, JJ; Ho, AL; Wintermark, M; Patel, SH; Pauly, KB; Kakusa, BW; Beres, SJ; Henderson, JM; Grant, GA; Halpern, CH
Published in: Oper Neurosurg (Hagerstown)
June 1, 2020

BACKGROUND: Laser interstitial thermal therapy (LITT) is a minimally invasive therapy for treating medication-resistant mesial temporal lobe epilepsy. Cranial nerve (CN) palsy has been reported as a procedural complication, but the mechanism of this complication is not understood. OBJECTIVE: To identify the cause of postoperative CN palsy after LITT. METHODS: Four medial temporal lobe epilepsy patients with CN palsy after LITT were identified for comparison with 22 consecutive patients with no palsy. We evaluated individual variation in the distance between CN III and the uncus, and CN IV and the parahippocampal gyrus using preoperative T1- and T2-weighted magnetic resonance (MR) images. Intraoperative MR thermometry was used to estimate temperature changes. RESULTS: CN III (n = 2) and CN IV palsies (n = 2) were reported. On preoperative imaging, the majority of identified CN III (54%) and CN IV (43%) were located within 1 to 2 mm of the uncus and parahippocampal gyrus tissue border, respectively. Affected CN III and CN IV were more likely to be found < 1 mm of the tissue border (PCNIII = .03, PCNIV < .01; chi-squared test). Retrospective assessment of thermal profile during ablation showed higher temperature rise along the mesial temporal lobe tissue border in affected CNs than unaffected CNs after controlling for distance (12.9°C vs 5.8°C; P = .03; 2-sample t-test). CONCLUSION: CN palsy after LITT likely results from direct heating of the respective CN running at extreme proximity to the mesial temporal lobe. Low-temperature thresholds set at the border of the mesial temporal lobe in patients whose CNs are at close proximity may reduce this risk.

Duke Scholars

Published In

Oper Neurosurg (Hagerstown)

DOI

EISSN

2332-4260

Publication Date

June 1, 2020

Volume

18

Issue

6

Start / End Page

684 / 691

Location

United States

Related Subject Headings

  • Thermometry
  • Retrospective Studies
  • Lasers
  • Laser Therapy
  • Humans
  • Epilepsy, Temporal Lobe
  • Cranial Nerve Diseases
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Huang, Y., Leung, S. A., Parker, J. J., Ho, A. L., Wintermark, M., Patel, S. H., … Halpern, C. H. (2020). Anatomic and Thermometric Analysis of Cranial Nerve Palsy after Laser Amygdalohippocampotomy for Mesial Temporal Lobe Epilepsy. Oper Neurosurg (Hagerstown), 18(6), 684–691. https://doi.org/10.1093/ons/opz279
Huang, Yuhao, Steven A. Leung, Jonathon J. Parker, Allen L. Ho, Max Wintermark, Sohil H. Patel, Kim Butts Pauly, et al. “Anatomic and Thermometric Analysis of Cranial Nerve Palsy after Laser Amygdalohippocampotomy for Mesial Temporal Lobe Epilepsy.Oper Neurosurg (Hagerstown) 18, no. 6 (June 1, 2020): 684–91. https://doi.org/10.1093/ons/opz279.
Huang Y, Leung SA, Parker JJ, Ho AL, Wintermark M, Patel SH, et al. Anatomic and Thermometric Analysis of Cranial Nerve Palsy after Laser Amygdalohippocampotomy for Mesial Temporal Lobe Epilepsy. Oper Neurosurg (Hagerstown). 2020 Jun 1;18(6):684–91.
Huang, Yuhao, et al. “Anatomic and Thermometric Analysis of Cranial Nerve Palsy after Laser Amygdalohippocampotomy for Mesial Temporal Lobe Epilepsy.Oper Neurosurg (Hagerstown), vol. 18, no. 6, June 2020, pp. 684–91. Pubmed, doi:10.1093/ons/opz279.
Huang Y, Leung SA, Parker JJ, Ho AL, Wintermark M, Patel SH, Pauly KB, Kakusa BW, Beres SJ, Henderson JM, Grant GA, Halpern CH. Anatomic and Thermometric Analysis of Cranial Nerve Palsy after Laser Amygdalohippocampotomy for Mesial Temporal Lobe Epilepsy. Oper Neurosurg (Hagerstown). 2020 Jun 1;18(6):684–691.
Journal cover image

Published In

Oper Neurosurg (Hagerstown)

DOI

EISSN

2332-4260

Publication Date

June 1, 2020

Volume

18

Issue

6

Start / End Page

684 / 691

Location

United States

Related Subject Headings

  • Thermometry
  • Retrospective Studies
  • Lasers
  • Laser Therapy
  • Humans
  • Epilepsy, Temporal Lobe
  • Cranial Nerve Diseases