{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T05:24:12Z","timestamp":1783574652033,"version":"3.55.0"},"reference-count":48,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2021,8,2]],"date-time":"2021-08-02T00:00:00Z","timestamp":1627862400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Epilepsia"],"published-print":{"date-parts":[[2021,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>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\u2010trajectory approach could improve ablation of all relevant MTL structures. First, we created large\u2010scale computer simulations to compare idealized one\u2010 vs two\u2010trajectory approaches. A two\u2010trajectory approach was then validated in an initial cohort of patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We used magnetic resonance imaging (MRI) from the Human Connectome Project (HCP) to create subject\u2010specific target structures consisting of hippocampus, amygdala, and piriform\/entorhinal\/perirhinal cortex. An algorithm searched for safe potential trajectories along the hippocampal axis (catheter one) and along the amygdala\u2010piriform axis (catheter two) and compared this to a single trajectory optimized over all structures. The proportion of each structure ablated at various burn radii was evaluated. A cohort of 11 consecutive patients with mTLE received two\u2010trajectory LITT; demographic, operative, and outcome data were collected.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The two\u2010trajectory approach was superior to the one\u2010trajectory approach at nearly all burn radii for all hippocampal subfields and amygdala nuclei (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a0.05). Two\u2010laser trajectories achieved full ablation of MTL cortical structures at physiologically realistic burn radii, whereas one\u2010laser trajectories could not. Five patients with at least 1\u00a0year of follow\u2010up (mean\u00a0=\u00a021.8\u00a0months) experienced Engel class I outcomes; 6 patients with less than 1\u00a0year of follow\u2010up (mean\u00a0=\u00a06.6\u00a0months) are on track for Engel class I outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Significance<\/jats:title><jats:p>Our anatomic analyses and initial clinical results suggest that LITT amygdalohippocampotomy performed via two\u2010laser trajectories may promote excellent seizure outcomes. Future studies are required to validate the long\u2010term clinical efficacy and safety of this approach.<\/jats:p><\/jats:sec>","DOI":"10.1111\/epi.17019","type":"journal-article","created":{"date-parts":[[2021,8,2]],"date-time":"2021-08-02T13:52:42Z","timestamp":1627912362000},"page":"2344-2356","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Two\u2010trajectory laser amygdalohippocampotomy: Anatomic modeling and initial seizure outcomes"],"prefix":"10.1111","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2313-1890","authenticated-orcid":false,"given":"David D.","family":"Liu","sequence":"first","affiliation":[{"name":"Department of Neurosurgery The Warren Alpert Medical School, Brown University Providence RI USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8569-6427","authenticated-orcid":false,"given":"Peter 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