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Mechanisms and Risk Factors Contributing to Visual Field Deficits following Stereotactic Laser Amygdalohippocampotomy

Voets, Natalie L.; Alvarez, Ivan; Qiu, Deqiang; Leatherday, Christopher; Willie, Jon T.; Sotiropoulos, Stamatios; Gleichgerrcht, Ezequiel; Bonilha, Leonardo; Pedersen, Nigel; Kadom, Nadja; Saindane, Amit; Gross, Robert E.; Drane, Daniel L.


Natalie L. Voets

Ivan Alvarez

Deqiang Qiu

Christopher Leatherday

Jon T. Willie

Ezequiel Gleichgerrcht

Leonardo Bonilha

Nigel Pedersen

Nadja Kadom

Amit Saindane

Robert E. Gross

Daniel L. Drane


Selective laser amygdalohippocampotomy (SLAH) is a minimally invasive surgical treatment for medial temporal lobe epilepsy. Visual field deficits (VFDs) are a significant potential complication. The objective of this study was to determine the relationship between VFDs and potential mechanisms of injury to the optic radiations and lateral geniculate nucleus. We performed a retrospective cross-sectional analysis of 3 patients (5.2%) who developed persistent VFDs after SLAH within our larger series (N=58), 15 healthy individuals and 10 SLAH patients without visual complications. Diffusion tractography was used to evaluate laser catheter penetration of the optic radiations. Using a complementary approach, we evaluated evidence for focal microstructural tissue damage within the optic radiations and lateral geniculate nucleus. Over-ablation and potential heat radiation were assessed by quantifying ablation and choroidal fissure CSF volumes as well as energy deposited during SLAH. SLAH treatment parameters did not distinguish VFD patients. Atypically high overlap between the laser catheter and optic radiations was found in 1 / 3 VFD patients, and was accompanied by focal reductions in fractional anisotropy where the catheter entered the lateral occipital white matter. Surprisingly, lateral geniculate tissue diffusivity was abnormal following, but also preceding, SLAH in patients who subsequently developed a VFD (all p ≤ 0.005). In our series, vision-related complications following SLAH, which appear to occur less frequently than following open temporal lobe surgery, were not directly explained by SLAH treatment parameters. Instead, our data suggest that variations in lateral geniculate structure may influence susceptibility to indirect heat injury from trans-occipital SLAH.


Voets, N. L., Alvarez, I., Qiu, D., Leatherday, C., Willie, J. T., Sotiropoulos, S., …Drane, D. L. (2019). Mechanisms and Risk Factors Contributing to Visual Field Deficits following Stereotactic Laser Amygdalohippocampotomy. Stereotactic and Functional Neurosurgery, 97(4), 255–265.

Journal Article Type Article
Acceptance Date Aug 9, 2019
Online Publication Date Oct 16, 2019
Publication Date 2019-12
Deposit Date Oct 15, 2019
Publicly Available Date Oct 17, 2020
Journal Stereotactic and Functional Neurosurgery
Print ISSN 1011-6125
Electronic ISSN 1423-0372
Publisher Karger Publishers
Peer Reviewed Peer Reviewed
Volume 97
Issue 4
Pages 255–265
Keywords Surgery; Clinical Neurology
Public URL
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