Waseem Hena, Vivas Andrew C, Vale Fernando L
Department of Neurosurgery and Brain Repair, Morsani College of Medicine, University of South Florida, 2 Tampa General Circle, USF Health, 7th Floor, Tampa, FL 33606, USA; Department of Neurology, Dartmouth Hitchcock Medical Center, 1 Medical Center Dr. Lebanon, NH 03766, USA.
Department of Neurosurgery and Brain Repair, Morsani College of Medicine, University of South Florida, 2 Tampa General Circle, USF Health, 7th Floor, Tampa, FL 33606, USA.
J Clin Neurosci. 2017 Apr;38:1-7. doi: 10.1016/j.jocn.2016.12.002. Epub 2016 Dec 23.
There is a new focus on minimally invasive treatments for medically refractory mesial temporal lobe epilepsy (MTLE). MRI-guided laser interstitial thermal therapy (MRgLITT) is one such minimally invasive procedure, which utilizes MRI guidance and real-time feedback to ablate an epileptogenic focus. A total of 38 patients presenting exclusively with MTLE and no other lesions (including neoplasia), who underwent MRgLITT were reviewed. We evaluated a number of outcome measures, including seizure freedom, neuropsychological performance, complications, and other considerations. Eighteen (53%) had an Engel class I outcome, 10 patients had repeat procedures/operations, and 12 post-procedural complications occurred. Follow-up time ranged from 6 to 38.5months. There was a decreased length of procedure time, hospitalization time, and analgesic requirement when compared to open surgery. In cases of well-localized MTLE this procedure may offer similar (albeit slightly lower) rates of seizure freedom versus traditional surgery. MRgLITT may be an alternative treatment option for high risk surgical patients and, more importantly, could increase referrals for surgery in patients with medically refractory MTLE. However, data is limited and long-term outcomes have not been evaluated. Further investigation is required to understand the potential of this minimally invasive technique for MTLE.
对于药物难治性内侧颞叶癫痫（MTLE），目前有了对微创治疗的新关注。MRI引导下的激光间质热疗（MRgLITT）就是这样一种微创手术，它利用MRI引导和实时反馈来消融致痫灶。我们回顾了38例仅表现为MTLE且无其他病变（包括肿瘤）并接受MRgLITT治疗的患者。我们评估了多项结果指标，包括无癫痫发作、神经心理表现、并发症及其他相关情况。18例（53%）达到恩格尔I级结果，10例患者接受了重复手术，术后出现12例并发症。随访时间为6至38.5个月。与开放手术相比，手术时间、住院时间和镇痛需求均有所减少。在MTLE定位良好的病例中，该手术与传统手术相比，无癫痫发作率相似（尽管略低）。MRgLITT可能是高风险手术患者的一种替代治疗选择，更重要的是，它可以增加药物难治性MTLE患者的手术转诊率。然而，数据有限，尚未评估长期结果。需要进一步研究以了解这种微创技术对MTLE的治疗潜力。
