Cancer Institute of New Jersey, Rutgers University.
Department of Neurological Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick; and.
J Neurosurg. 2016 Oct;125(4):853-860. doi: 10.3171/2015.7.JNS15244. Epub 2016 Jan 1.
OBJECTIVE MR-guided laser-induced thermal therapy (MRgLITT) can be used to treat intracranial tumors, epilepsy, and chronic pain syndromes. Here, the authors report their single-center experience with 102 patients, the largest series to date in which the Visualase thermal therapy system was used. METHODS A retrospective analysis of all patients who underwent MRgLITT between 2010 and 2014 was performed. Pathologies included glioma, recurrent metastasis, radiation necrosis, chronic pain, and epilepsy. Laser catheters were placed stereotactically, and ablation was performed in the MRI suite. Demographics, operative parameters, length of hospital stay, and complications were recorded. Thirty-day readmission rates were calculated by using the standard method according to America's Health Insurance Plans Center for Policy and Research guidelines. RESULTS A total of 133 lasers were placed in 102 patients who required intervention for intracranial tumors (87 patients), chronic pain syndrome (cingulotomy, 5 patients), or epilepsy (10 patients). The procedure was completed in 98% (100) of these patients. Ninety-two patients (90.2%) had undergone previous treatment for their intracranial tumors. The average (± SD) total procedural time was 170.5 ± 34.4 minutes, and the mean laser-on time was 8.7 ± 6.8 minutes. The average intensive care unit (ICU) and hospital stays were 1.8 and 3.6 days, respectively, and the median length of stay for both the ICU and the hospital was 1 day. By postoperative Day 1, 54% of the patients (n = 55) were neurologically stable for discharge. There were 27 cases of morbidity, including new-onset neurological deficits, and 2 perioperative deaths. Fourteen patients (13.7%) developed new deficits after the MRgLITT procedure, and of those 14 patients, 64.3% (n = 9) had complete resolution of deficits within 1 month, 7.1% (n = 1) had partial resolution of symptoms within 1 month, 14.3% (n = 2) had not had resolution of symptoms at the most recent follow-up, and 14.3% (n = 2) died without resolution of symptoms. The 30-day readmission rate was 5.6% CONCLUSIONS MRgLITT, although minimally invasive, must be used with caution. Thermal damage to critical and eloquent structures can occur despite MRI guidance. Once the learning curve is overcome, the overall procedural complication rate is low, and most patients can be discharged within 24 hours, with a relatively low readmission rate. In cases in which they occurred, most neurological deficits were temporary. The therapeutic role of MRgLITT in various intracranial diseases will require larger and more rigorous studies.
目的
磁共振引导激光间质热疗（MRgLITT）可用于治疗颅内肿瘤、癫痫和慢性疼痛综合征。本文作者报告了他们在 102 例患者中开展的单中心经验，这是迄今为止使用 Visualase 热疗系统的最大系列研究。
方法
对 2010 年至 2014 年间接受 MRgLITT 的所有患者进行回顾性分析。病变包括胶质瘤、复发性转移、放射性坏死、慢性疼痛和癫痫。立体定向放置激光导管，并在磁共振室进行消融。记录患者的人口统计学、手术参数、住院时间和并发症。根据美国健康保险计划中心政策和研究指南的标准方法计算 30 天再入院率。
结果
共对 102 例需要颅内肿瘤（87 例）、慢性疼痛综合征（扣带回切开术，5 例）或癫痫（10 例）干预的患者进行了 133 次激光治疗。98%（100 例）的患者完成了手术。92 例（90.2%）患者曾因颅内肿瘤接受过治疗。平均（±SD）总手术时间为 170.5±34.4 分钟，激光照射时间为 8.7±6.8 分钟。平均重症监护病房（ICU）和住院时间分别为 1.8 天和 3.6 天，ICU 和医院的中位数住院时间均为 1 天。术后第 1 天，54%（55 例）患者神经稳定，可出院。共有 27 例出现发病率，包括新发神经功能缺损，2 例围手术期死亡。14 例患者（13.7%）在 MRgLITT 手术后出现新的缺陷，其中 14.3%（9 例）在 1 个月内完全缓解症状，7.1%（1 例）在 1 个月内部分缓解症状，14.3%（2 例）在最近一次随访时仍未缓解症状，14.3%（2 例）死亡，症状未缓解。30 天再入院率为 5.6%。
结论
MRgLITT 虽然微创，但必须谨慎使用。尽管有磁共振引导，但仍可能发生对关键和重要结构的热损伤。一旦克服了学习曲线，整体手术并发症发生率较低，大多数患者可在 24 小时内出院，再入院率相对较低。在出现的情况下，大多数神经功能缺损是暂时的。MRgLITT 在各种颅内疾病中的治疗作用需要更大、更严格的研究。
