Objective To provide a review of cognitive outcomes across a full neuropsychological profile in patients who underwent laser interstitial thermal therapy (LiTT) for mesiotemporal epilepsy (mTLE). Methods We examined cognitive outcomes following LiTT for mTLE by reviewing a consecutive series of 26 patients who underwent dominant or nondominant hemisphere procedures. Each patient9s pre- and postsurgical performance was examined for clinically significant change (>1SD improvement or decline on standardized scores), with a neuropsychologic battery that included measures of language, memory, executive functioning, and processing speed. Results Presurgical performance was largely consistent with previous research, where patients suffering from dominant hemisphere epilepsies demonstrated deficits in verbal learning and memory, whereas patients with nondominant hemisphere scored lower on visually mediated tests. Case-by-case review comparing presurgical to postsurgical scores revealed clinically significant improvement in both dominant and nondominant patients in learning and memory and other aspects of cognition such as processing speed and executive functioning. Of the few patients who did experience clinically significant decline following LiTT, a greater proportion had undergone dominant hemisphere procedures. Conclusions Compared with the outcome literature of dominant open anterior temporal lobectomies (ATLs), where postsurgical decline has been documented in up to 40%–60% of cases, our LiTT case series exhibited a much lower incidence of postoperative language or verbal memory decline. Moreover, promising rates of postoperative improvements were also observed across multiple cognitive domains. Future studies exploring cognitive outcomes following LiTT should include comprehensive neuropsychological findings, rather than only select domains, as clinically significant change can occur in areas other than those typically associated with mesiotemporal structures.

This video demonstrates the awake endoscopic minimally-invasive transforaminal lumbar interbody fusion (MIS-TLIF) used in our institution's developing Enhanced Recovery After Surgery program. This technique relies on 6 key components, including (1) conscious sedation, (2) endoscopic visualization, (3) long-acting local anesthesia, (4) an expandable interbody device, (5) osteobiologics, and (6) percutaneous instrumentation. In joining these technologies, this procedure embodies the principles of minimally invasive surgery while achieving excellent clinical outcomes. We have previously described this procedure in detail, as well as its impact at our institution, including significant reductions in operative time, blood loss, postoperative length of stay, and hospital costs. The procedure depicted in this video involves the off-label use of bone morphogenetic protein-2 and the Spineology Optimesh allograft containment device. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The patient gave direct consent for the use of the video footage and associated information from this surgery for the making and publication of this surgical video.