Introduction

Laser interstitial thermal therapy (LITT) has emerged over the past decade as an effective alternative to standard open surgical techniques for patients with drug-resistant temporal lobe epilepsy (TLE). Although LITT has been widely adopted, there is significant variability in reported seizure freedom outcomes.

Methods

We conducted a retrospective review of adult patients who underwent either LITT or open surgery for epilepsy at our institution between June 2014 and December 2023. Patients were included if they had undergone epilepsy surgery with curative intent and had at least 12 months of follow-up. Of the patients reviewed, 78 met the criteria and were included in our study. We used Fisher’s exact test to evaluate the outcome differences in laser versus open epilepsy surgery.

Results

Among the 51 patients who underwent open temporal lobe surgery, 71% achieved Engel 1 outcomes at 1-year post-op, and 61% remained Engel 1 at the latest follow-up. For the 27 patients who underwent LITT, 67% achieved Engel 1 outcomes at 1-year post-op, and 48% remained Engel 1 at the latest follow-up. The difference in Engel 1 outcomes between open and LITT patients was not statistically significant, with p-values greater than 0.05 at all time points. Subgroup analysis of anterior temporal lobectomy (ATL), selective amygdalohippocampectomy (SAH), and stereotactic laser amygdalohippocampectomy (SLAH) showed Engel 1 outcome rates of 87%, 64%, and 70% at 1-year post-op, decreasing to 67%, 56%, and 52% at the latest follow-up, respectively. Favorable outcomes (Engel Class 1-2) at the latest follow-up visit were similar across ATL, SAH, and SLAH at 94%, 88%, and 87%, respectively.

Conclusions

Open and LITT surgeries for TLE display similar rates of seizure freedom at 1-year post-op, with a decline in seizure freedom for LITT patients at latest follow-up. However, when examining favorable outcomes, rather than seizure freedom alone, there is little difference between LITT and open surgery.