Percutaneous selective laser amygdalo-hippocampectomy (SLAH) for treatment of mesial temporal lobe epilepsy within an interventional MRI suite

Abstract Percutaneous selective laser amygdalo-hippocampectomy (SLAH) procedure is a new minimally invasive alternative to surgical amygdalo-hippocampectomy that involves targeted, controlled laser energy deposition under real-time magnetic resonance imaging (MRI) monitoring within a dedicated “interventional MRI” suite. Technical feasibility, safety and initial efficacy results from our program are encouraging and indicate a potential for paradigm shift in future treatment of patients with exclusively or predominantly focal unilateral seizure onsets within the mesial temporal lobe. Several institutions are currently employing this technology and more long-term follow-up results on larger cohorts of patients are expected in the near future. This article reviews the principles of MRI-guided SLAH, procedure set-up and equipment, the detailed phases of intra-procedural MRI guidance and treatment monitoring, and the MRI appearance of the resultant thermal ablation zones. We conclude with a discussion of our institutional experience at Emory University with MRI-guided SLAH as one of the leading sites offering this state-of-the-art technology.