The use of MRI-guided laser-induced thermal ablation for epilepsy
The use of MRI-guided laser-induced thermal ablation for epilepsy
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DOI：
10.1007/s00381-013-2169-6
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发表时间：
2013-11-01
影响因子：
1.4
通讯作者：
Huckins, Sean
中科院分区：
文献类型：
--
作者：
Tovar-Spinoza, Zulma;Carter, David;Huckins, Sean
目的癫痫外科正在不断探索治疗难治性癫痫的新方法。MRI引导下激光热消融治疗癫痫是一种令人兴奋的微创新技术，可用于各种致痫灶的病灶切除术（下丘脑错构瘤，皮质发育不良，皮质畸形，结节）或作为一种断开工具，允许一种新的治疗选择，而无需开放手术的麻烦。MRI引导的激光间质热治疗（MRgLITT）是一种破坏组织的程序，使用热量。为了以微创方式输送这种能量，通过锁孔立体定向手术将小直径光纤施加器插入病变。热能诱导细胞内DNA和DNA结合结构的损伤，最终导致细胞死亡。消融过程由实时MRI热标测进行监督，并由消融后即刻T1或FLAIR MRI图像进行确认。本报告概述了MR引导激光消融治疗（称为MRI引导激光间质热治疗（MRgLITT））的发展和实践。现代图像引导的轨迹规划在MRgLITT中的作用也将被讨论，特别强调使用这种新颖的微创技术治疗难治性癫痫。MRI引导的激光诱导热消融治疗癫痫是一种令人兴奋的新的微创技术，每天都在神经外科领域发现潜在的新应用。它当然为我们实践癫痫手术的方式带来了新的视角，即使长期的结果应该得到适当的收集和分析。
Purpose Epilepsy surgery is constantly researching for new options for patients with refractory epilepsy. MRI-guided laser-induced thermal ablation for epilepsy is an exciting new minimally invasive technology with an emerging use for lesionectomy of a variety of epileptogenic focuses (hypothalamic hamartomas, cortical dysplasias, cortical malformations, tubers) or as a disconnection tool allowing a new option of treatment without the hassles of an open surgery.MRI-guided laser interstitial thermal therapy (MRgLITT) is a procedure for destroying tissue-using heat. To deliver this energy in a minimally invasive fashion, a small diameter fiber optic applicator is inserted into the lesion through a keyhole stereotactic procedure. The thermal energy induces damage to intracellular DNA and DNA-binding structures, ultimately leading to cell death. The ablation procedure is supervised by real-time MRI thermal mapping and confirmed by immediate post-ablation T1 or FLAIR MRI images.The present report includes an overview of the development and practice of an MR-guided laser ablation therapy known as MRI-guided laser interstitial thermal therapy (MRgLITT). The role of modern image-guided trajectory planning in MRgLITT will also be discussed, with particular emphasis on the treatment of refractory epilepsy using this novel, minimally invasive technique.MRI-guided laser-induced thermal ablation for epilepsy is an exciting new minimally invasive technology that finds potential new applications every day in the neurosurgical field. It certainly brings a new perspective on the way we practice epilepsy surgery even though long-term results should be properly collected and analyzed.