Two‐trajectory laser amygdalohippocampotomy: Anatomic modeling and initial seizure outcomes

Abstract

Laser interstitial thermal therapy (LITT) for mesial temporal lobe epilepsy (mTLE) is typically performed with one trajectory to target the medial temporal lobe (MTL). MTL structures such as piriform and entorhinal cortex are epileptogenic, but due to their relative geometry, they are difficult to target with one trajectory while simultaneously maintaining adequate ablation of the amygdala and hippocampus. We hypothesized that a two‐trajectory approach could improve ablation of all relevant MTL structures. First, we created large‐scale computer simulations to compare idealized one‐ vs two‐trajectory approaches. A two‐trajectory approach was then validated in an initial cohort of patients.