Willie Jon T, Laxpati Nealen G, Drane Daniel L, Gowda Ashok, Appin Christina, Hao Chunhai, Brat Daniel J, Helmers Sandra L, Saindane Amit, Nour Sherif G, Gross Robert E
Departments of *Neurosurgery, ‡Neurology, §Pathology, and ¶Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia; ‖Interventional MRI Program, Emory University Hospital, Atlanta, Georgia; #Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia; **Department of Neurology, University of Washington School of Medicine, Seattle, Washington; ††Visualase, Inc., Houston, Texas.
Neurosurgery. 2014 Jun;74(6):569-84; discussion 584-5. doi: 10.1227/NEU.0000000000000343.
Open surgery effectively treats mesial temporal lobe epilepsy, but carries the risk of neurocognitive deficits, which may be reduced with minimally invasive alternatives.
To describe technical and clinical outcomes of stereotactic laser amygdalohippocampotomy with real-time magnetic resonance thermal imaging guidance.
With patients under general anesthesia and using standard stereotactic methods, 13 adult patients with intractable mesial temporal lobe epilepsy (with and without mesial temporal sclerosis [MTS]) prospectively underwent insertion of a saline-cooled fiberoptic laser applicator in amygdalohippocampal structures from an occipital trajectory. Computer-controlled laser ablation was performed during continuous magnetic resonance thermal imaging 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 1 day. With follow-up ranging from 5 to 26 months (median, 14 months), 77% (10/13) of patients achieved meaningful seizure reduction, of whom 54% (7/13) were free of disabling seizures. Of patients with preoperative MTS, 67% (6/9) achieved seizure freedom. All recurrences were observed before 6 months. Variances in ablation volume and length did not account for individual clinical outcomes. Although no complications of laser therapy itself were observed, 1 significant complication, a visual field defect, resulted from deviated insertion of a stereotactic aligning rod, which was corrected before ablation.
Real-time magnetic resonance-guided stereotactic laser amygdalohippocampotomy is a technically novel, safe, and effective alternative to open surgery. Further evaluation with larger cohorts over time is warranted.
开放手术能有效治疗内侧颞叶癫痫，但存在神经认知功能缺损的风险，而微创替代方案可能会降低这种风险。
描述在实时磁共振热成像引导下进行立体定向激光杏仁核海马切除术的技术和临床结果。
13例成年难治性内侧颞叶癫痫患者（伴或不伴内侧颞叶硬化症[MTS]）在全身麻醉下，采用标准立体定向方法，经枕部轨迹将盐水冷却的光纤激光探头插入杏仁核海马结构。在连续磁共振热成像过程中进行计算机控制的激光消融，随后进行对比增强解剖成像和容积重建。根据癫痫日记确定临床结果。
13例患者（9例伴有MTS）接受了15次手术，杏仁核海马复合体平均消融体积为60%。中位住院时间为1天。随访时间为5至26个月（中位时间为14个月），77%（10/13）的患者癫痫发作得到有意义的减少，其中54%（7/13）的患者无致残性癫痫发作。术前伴有MTS的患者中，67%（6/9）实现了癫痫发作自由。所有复发均在6个月前观察到。消融体积和长度的差异不能解释个体临床结果。虽然未观察到激光治疗本身的并发症，但1例严重并发症，即视野缺损，是由立体定向定位杆插入偏差导致的，在消融前已纠正。
实时磁共振引导下的立体定向激光杏仁核海马切除术是一种技术新颖、安全有效的开放手术替代方案。有必要随着时间推移对更大的队列进行进一步评估。
