Real-time magnetic resonance-guided stereotactic laser amygdalohippocampotomy for mesial temporal lobe epilepsy.
Real-time magnetic resonance-guided stereotactic laser amygdalohippocampotomy for mesial temporal lobe epilepsy.
复制标题
实时磁共振引导的立体定向激光杏仁核膜切开术，用于中颞叶癫痫。
DOI：
10.1227/neu.0000000000000343
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发表时间：
2014-06
期刊：
影响因子：
4.8
通讯作者：
Gross RE
中科院分区：
文献类型：
--
作者：
Willie JT;Laxpati NG;Drane DL;Gowda A;Appin C;Hao C;Brat DJ;Helmers SL;Saindane A;Nour SG;Gross RE
开放手术有效治疗内侧颞叶癫痫（MTLE），但存在神经认知缺陷的风险，可以通过微创替代方法减少。描述实时磁共振热成像（MRTI）引导下立体定向激光杏仁核海马切开术（SLAH）的技术和临床结果。在全身麻醉和标准立体定向方法下，13例成人顽固性MTLE（伴或不伴内侧颞叶硬化，MTS）患者前瞻性地从枕部轨迹将盐冷却光纤激光应用器插入杏仁核海马结构。计算机控制的激光消融在连续MRTI期间进行，随后进行验证性对比增强解剖成像和体积重建。临床结果由发作日记确定。13例患者（9例为MTS）接受了15次手术，平均60%的杏仁核海马复合体体积被消融。平均住院时间为1天。随访5-26个月（中位14个月），77%（10/13）患者癫痫发作明显减少，其中54%（7/13）患者无致残性癫痫发作。术前MTS患者中，67%（6/9）实现了癫痫发作自由。所有复发均在<6个月时观察到。消融体积和长度的差异不能解释个体的临床结果。虽然没有观察到激光治疗本身的并发症，但有一个明显的并发症，即视野缺损，是由立体定向对准棒的偏离插入引起的，在消融之前进行了纠正。实时mr引导的slh是一种技术新颖、安全、有效的开放式手术替代方案。随着时间的推移，有必要对更大的队列进行进一步评估。
Open surgery effectively treats mesial temporal lobe epilepsy (MTLE), but carries risks of neurocognitive deficits, which may be reduced with minimally invasive alternatives. To describe technical and clinical outcomes of stereotactic laser amygdalohippocampotomy (SLAH) with real-time magnetic resonance thermal imaging (MRTI) guidance. Under general anesthesia and utilizing standard stereotactic methods, 13 adult patients with intractable MTLE (with and without mesial temporal sclerosis, MTS) prospectively underwent insertion of a saline-cooled fiber-optic laser applicator into amygdalohippocampal structures from an occipital trajectory. Computer-controlled laser ablation was performed during continuous MRTI followed by confirmatory contrast-enhanced anatomic imaging and volumetric reconstruction. Clinical outcomes were determined from seizure diaries. A mean 60% volume of the amygdalohippocampal complex was ablated in 13 patients (9 with MTS) undergoing 15 procedures. Median hospitalization was one day. With follow-up ranging from 5-26 (median 14) months, 77% (10/13) of patients achieved meaningful seizure reduction, of which 54% (7/13) were free of disabling seizures. Of patients with preoperative MTS, 67% (6/9) achieved seizure freedom. All recurrences were observed by<6 months. Variances in ablation volume and length did not account for individual clinical outcomes. Whereas no complications of laser therapy itself were observed, one significant complication, a visual field defect, resulted from deviated insertion of a stereotactic aligning rod, which was corrected prior to ablation. Real-time MR-guided SLAH is a technically novel, safe, and effective alternative to open surgery. Further evaluation with larger cohorts over time is warranted.