A neurosurgeon's view: Laser interstitial thermal therapy of mesial temporal lobe structures
A neurosurgeon's view: Laser interstitial thermal therapy of mesial temporal lobe structures
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DOI：
10.1016/j.eplepsyres.2017.10.015
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发表时间：
2018-05-01
影响因子：
2.2
通讯作者：
Gross, Robert E.
中科院分区：
文献类型：
--
作者：
Bezchlibnyk, Yarema B.;Willie, Jon T.;Gross, Robert E.
立体定向激光消融颞叶内侧结构是治疗颞叶内侧癫痫（MTLE）的一种新的有前途的手术方法。自该手术于2010年首次用于治疗MILE以来，文献中包含了37例使用激光间质热治疗（LITT）进行MR引导立体定向激光杏仁核切除术（SLAH）并至少随访1年的患者的报告。这些早期的数据表明，SLAH是一种安全有效的治疗MILE的适当选择的患者。此外，与包括标准前颞叶切除术及其更具选择性的变体在内的开放性外科手术相比，SLAH的侵入性显著降低，与MTLE的放射外科治疗相比，SLAH导致组织的立即破坏，并且与采用射频消融的技术相比，可以更容易地消融更大体积的组织。最后，越来越多的证据表明，与开放手术相比，SLAH与神经心理缺陷的总体风险较低相关。因此，LITT构成了神经外科医生用于管理医学难治性癫痫发作的一种新型微创工具，可以吸引符合条件的患者考虑手术干预来管理他们的癫痫发作。
Stereotactic laser ablation of mesial temporal structures is a promising new surgical intervention for patients with mesial temporal lobe epilepsy (MTLE). Since this procedure was first used to treat MILE in 2010, the literature contains reports of 37 patients that underwent MR-guided stereotactic laser amygdalohippocampotomy (SLAH) using Laser Interstitial Thermal Therapy (LITT) with at least 1 year of follow-up. This early body of data suggests that SLAH is a safe and effective treatment for MILE in properly selected patients. Moreover, SLAH is substantially less invasive when compared with open surgical procedures including standard anterior temporal lobectomy and its more selective variants, results in immediate destruction of tissue in contrast to radiosurgical treatments for MTLE, and can more readily ablate larger volumes of tissue than is possible with techniques employing radiofrequency ablation. Finally, evidence is accruing that SLAH is associated with lower overall risk of neuropsychological deficits compared to open surgery. Thus, LITT constitutes a novel minimally invasive tool in the neurosurgeon's armamentarium for managing medically refractory seizures that may draw eligible patients to consider surgical interventions to manage their seizures.