Acute V3 Hypesthesia following Laser Interstitial Thermal Therapy for Drug-Resistant Epilepsy

Abstract

Three studies have reported trigeminal hypesthesia following temporal lobe resection. However, no cases of hypesthesia have been reported following laser interstitial thermal therapy (LITT). We report the first case of trigeminal hypesthesia as a complication of otherwise successful LITT in a patient with drug-resistant epilepsy. A 58-year-old male with drug-resistant epilepsy secondary to a left parahippocampal gyrus multinodular and vacuolating neuronal tumor underwent biopsy and MRI-guided LITT. Immediately postoperatively, the patient reported hypesthesia in the left V3 distribution, including inside the mouth and ear. At 6-month follow-up, hypesthesia was present but improving, and the patient was seizure-free. While the cerebellopontine angle and prepontine cisterns are considered thermal insulators, we hypothesize that thermal injury was conducted through these spaces to the cisternal segment of the trigeminal nerve or to the inferior V3 branch in Meckel’s cave. Moreover, real-time visualization of the ablation is impacted by a blind spot at the skull base, created from bone disruption of MRI thermography.