From resection to ablation: A review of resective surgical options for temporal lobe epilepsy and rationale for an ablation-based approach

Surgical intervention is of proven benefit in an appropriately selected subset of patients with medically refractory temporal lobe epilepsy. In these patients, a surgical cure both provides the quality of life improvement that comes from seizure freedom as well as a survival benefit. However, patients who undergo open surgical intervention may have a worsening in neurobehavioral outcomes. Laser interstitial thermal therapy (LITT) represents a minimally invasive surgical intervention that has shown promise in improving post-operative neurobehavioral outcomes. Further, the minimally invasive nature of this procedure holds the possibility to shift the significant under-penetration of surgical intervention that exists for eligible medically refractory patients. Herein, we review open surgical resection-based techniques and the clinical data to date for LITT.