Vivian L. Smith Department of Neurosurgery, University of Texas Health Science Center at Houston, Medical School, Houston, TX, USA.
Department of Neurology, University of Texas Health Science Center at Houston, Medical School, Houston, TX, USA.
Epilepsy Res. 2014 Mar;108(3):547-54. doi: 10.1016/j.eplepsyres.2014.01.009. Epub 2014 Jan 30.
Periventricular nodular heterotopia (PVNH) is a neuronal migrational disorder often associated with pharmacoresistant epilepsy (PRE). Resective surgery for PVNH is limited by its deep location, and the overlying eloquent cortex or white matter. Stereotactic MR guided laser interstitial thermal therapy (MRgLITT) has recently become available for controlled focal ablation, enabling us to target these lesions. We here demonstrate the novel application and techniques for the use of MRgLITT in the management of PVNH epilepsy. Comprehensive presurgical evaluation, including intracranial EEG monitoring in two patients revealed the PVNH to be crucially involved in their PRE. We used MRgLITT to maximally ablate the PVNH in both cases. In the first case, seizure medication adjustment coupled with PVNH ablation, and in the second, PVNH ablation in addition to temporal lobectomy rendered the patient seizure free. A transient visual deficit occurred following ablation in the second patient. MRgLITT is a promising minimally invasive technique for ablation of epileptogenic PVNH, a disease not generally viewed as surgically treatable epilepsy. We also show here the feasibility of applying this technique through multiple trajectories and to create lesions of complex shapes. The broad applicability and long term efficacy of MRgLITT need to be elaborated further.
室管膜下结节性异位（PVNH）是一种神经元迁移障碍，常与药物难治性癫痫（PRE）有关。由于其位置深，且位于功能区皮层或白质上方，因此针对 PVNH 的切除术受到限制。立体定向磁共振引导激光间质热疗（MRgLITT）最近已可用于控制焦点消融，使我们能够针对这些病变进行治疗。我们在此展示了 MRgLITT 在 PVNH 癫痫治疗中的新应用和技术。对两名患者进行了全面的术前评估，包括颅内 EEG 监测，结果显示 PVNH 对他们的 PRE 至关重要。我们在这两种情况下都使用了 MRgLITT 来最大程度地消融 PVNH。在第一种情况下，通过调整抗癫痫药物和 PVNH 消融来治疗癫痫，在第二种情况下，除了颞叶切除术外，还进行了 PVNH 消融，使患者无癫痫发作。在第二位患者中，消融后出现短暂的视力障碍。MRgLITT 是一种有前途的微创技术，可用于消融致痫性 PVNH，这种疾病通常不被认为是可通过手术治疗的癫痫。我们还在此展示了通过多条轨迹应用该技术并创建复杂形状病变的可行性。MRgLITT 的广泛适用性和长期疗效还需要进一步阐述。
