MRI-Guided Interstitial Laser Ablation for Intracranial Lesions: A Large Single-Institution Experience of 133 Cases
MRI-Guided Interstitial Laser Ablation for Intracranial Lesions: A Large Single-Institution Experience of 133 Cases
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DOI：
10.1159/000485387
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发表时间：
2017-01-01
影响因子：
1.7
通讯作者：
Leuthardt, Eric C.
中科院分区：
文献类型：
--
作者：
Kamath, Ashwin A.;Friedman, Daniel D.;Leuthardt, Eric C.
背景：在脆弱的患者中，处理难以触及的病变或手术可触及的病变是神经外科的一个中心问题。MRI引导下的间质激光消融术(ILA)是一种微创的选择，可能为治疗这些具有挑战性的患者提供一种安全的手段。目的：我们的目标是(1)评估不同的大系列ILA治疗的安全性、有效性和初步结果；(2)报道作者的经验证明随着时间的推移有用的技术细节和手术趋势，这可能对实施ILA的神经外科医生有用。方法：对ILA患者的人口统计学、手术技术和临床结果进行回顾性评估。结果：120例患者共133个颅内病变接受ILA治疗，包括胶质母细胞瘤、其他胶质瘤、转移瘤、癫痫灶和放射性坏死。并发症/意外再住院率为6.0%，病死率为2.2%。对于高级别的肿瘤，肿瘤体积和直径3厘米有增加并发症发生率的趋势(p=0.056)。复发GBM的中位无进展生存期(PFS)为7.4个月，总生存期(OS)为11.6个月。作为新诊断的GBM的一线治疗，中位PFS和OS分别为5.9个月和11.4个月。对于转移瘤，中位PFS尚未达到，OS为17.2个月。结论：ILA是一种安全有效的治疗各种颅内疾病的方法，可为治疗难以触及的病变量身定做，并可能为选择合适的患者提供一种新的开颅手术选择。(C)2018年作者(S)，由S.Karger AG，巴塞尔出版。
Background: Managing difficult-to-access lesions or surgically accessible lesions in fragile patients is a central problem in neurosurgery. MRI-guided interstitial laser ablation (ILA) is a minimally invasive option that may provide a safe means of treating these challenging patients. Objective: We aim to (1) evaluate safety, efficacy, and preliminary outcomes within a diverse and large series of ILA treatments; and (2) report technical details and operative trends that proved useful over time in the authors' experience and that may be of use to neurosurgeons who perform ILA. Methods: A retrospective evaluation of ILA patients was performed in terms of demographics, surgical techniques, and clinical outcomes. Results: A total of 133 intracranial lesions in 120 patients were treated with ILA, including glioblastomas (GBM), other gliomas, metastases, epilepsy foci, and radionecrosis. The rate of complications/unexpected readmission was 6.0%, and the mortality rate was 2.2%. With high-grade tumors, tumor volumes > 3 cm in diameter trended toward a higher rate of complication (p = 0.056). Median progression-free survival (PFS) and overall survival (OS) for recurrent GBM were 7.4 and 11.6 months, respectively. As a frontline treatment for newly diagnosed GBM, median PFS and OS were 5.9 and 11.4 months, respectively. For metastases, median PFS was not yet reached, and OS was 17.2 months. Conclusion: Our series suggests that ILA is a safe and efficacious treatment for a variety of intracranial pathologies, can be tailored to treat difficult-to-access lesions, and may offer a novel alternative to open craniotomy in properly selected patients. (c) 2018 The Author(s) Published by S. Karger AG, Basel.