Buckley Robert T, Wang Anthony C, Miller John W, Novotny Edward J, Ojemann Jeffrey G
Divisions of 1 Neurological Surgery and.
Department of Neurology, University of Washington School of Medicine, Seattle, Washington.
Neurosurg Focus. 2016 Oct;41(4):E10. doi: 10.3171/2016.7.FOCUS16236.
OBJECTIVE Laser ablation is a novel, minimally invasive procedure that utilizes MRI-guided thermal energy to treat epileptogenic and other brain lesions. In addition to treatment of mesial temporal lobe epilepsy, laser ablation is increasingly being used to target deep or inoperable lesions, including hypothalamic hamartoma (HH), subependymal giant cell astrocytoma (SEGA), and exophytic intrinsic hypothalamic/third ventricular tumors. The authors reviewed their early institutional experience with these patients to characterize clinical outcomes in patients undergoing this procedure. METHODS A retrospective cohort (n = 12) of patients undergoing laser ablation at a single institution was identified, and clinical and radiographic records were reviewed. RESULTS Laser ablation was successfully performed in all patients. No permanent neurological or endocrine complications occurred; 2 (17%) patients developed acute obstructive hydrocephalus or shunt malfunction following treatment. Laser ablation of HH resulted in seizure freedom (Engel Class I) in 67%, with the remaining patients having a clinically significant reduction in seizure frequency of greater than 90% compared with preoperative baseline (Engel Class IIB). Treatment of SEGAs resulted in durable clinical and radiographic tumor control in 2 of 3 cases, with one patient receiving adjuvant everolimus and the other receiving no additional therapy. Palliative ablation of hypothalamic/third ventricular tumors resulted in partial tumor control in 1 of 3 patients. CONCLUSIONS Early experience suggests that laser ablation is a generally safe, durable, and effective treatment for patients harboring HHs. It also appears effective for local control of SEGAs, especially in combination therapy with everolimus. Its use as a palliative treatment for intrinsic hypothalamic/deep intraventricular tumors was less successful and associated with a higher risk of serious complications. Additional experience and long-term follow-up will be beneficial in further characterizing the effectiveness and risk profile of laser ablation in treating these lesions in comparison with conventional resective surgery or stereotactic radiosurgery.
目的 激光消融是一种新型的微创治疗方法，利用磁共振成像（MRI）引导的热能来治疗致痫性及其他脑病变。除了治疗内侧颞叶癫痫外，激光消融越来越多地用于靶向深部或无法手术切除的病变，包括下丘脑错构瘤（HH）、室管膜下巨细胞星形细胞瘤（SEGA）以及外生性下丘脑/第三脑室肿瘤。作者回顾了他们在本机构对这些患者的早期治疗经验，以描述接受该手术患者的临床结局。方法 确定了在单一机构接受激光消融的回顾性队列（n = 12）患者，并对临床和影像学记录进行了回顾。结果 所有患者均成功进行了激光消融。未发生永久性神经或内分泌并发症；2例（17%）患者在治疗后出现急性梗阻性脑积水或分流故障。HH的激光消融使67%的患者实现无癫痫发作（Engel I级），其余患者与术前基线相比癫痫发作频率临床显著降低超过90%（Engel IIB级）。SEGA的治疗在3例中有2例实现了持久的临床和影像学肿瘤控制，1例患者接受辅助依维莫司治疗，另1例未接受额外治疗。下丘脑/第三脑室肿瘤的姑息性消融在3例患者中有1例实现了部分肿瘤控制。结论 早期经验表明，激光消融对于患有HH的患者是一种总体安全、持久且有效的治疗方法。它对于SEGA的局部控制似乎也有效，特别是与依维莫司联合治疗时。其作为下丘脑/脑室内深部肿瘤的姑息性治疗效果较差，且严重并发症风险较高。与传统切除术或立体定向放射外科相比，更多的经验和长期随访将有助于进一步明确激光消融治疗这些病变的有效性和风险概况。
