Department of Neurosurgery, Cleveland Clinic, Ohio.
Epilepsy Center, Cleveland Clinic, Cleveland, Ohio.
Oper Neurosurg (Hagerstown). 2018 Dec 1;15(6):656-663. doi: 10.1093/ons/opy022.
Laser ablation surgery has had encouraging results in the treatment of multiple intracranial diseases including primary and metastatic brain tumors, radiation necrosis, and epilepsy. The use of the stereoelectroencephalography (SEEG) method in combination with laser thermocoagulation therapy with the goal of modulating epileptic networks in patients with neocortical nonlesional phamacoresistant epilepsy has not been previously described.
To describe the novel methodological and conceptual aspects related to SEEG-guided laser ablations in patients with magnetic resonance imaging (MRI)-negative pharmacoresistant neocortical focal epilepsy.
Guided by previous SEEG intracranial data, a laser ablation probe was inserted by using a robotic guidance device in a 17-yr-old medically refractory epilepsy patient with difficult to localize seizures and nonlesional MRI. The laser applicator position was confirmed by MRI, targeting the left mesial rostral superior frontal gyrus. The ablation was performed under multiplanar digital imaging views and real-time thermal imaging and treatment estimates in each plane. A postablation MRI (contrasted T1 sequence) confirmed the ablation's location and size.
The entire procedure was achieved in approximately 100 min. The actual ablation was performed in less than 3 min. Approximately, additional 30 min preoperatively were used for positioning and robot registration. Precise placement of laser application (in comparison with preplanned trajectories) was achieved using the robotic guidance and confirmed by the intraoperative magnetic resonance images. No complications were reported. The patient has been seizure-free since surgery. The follow-up period is 20 mo. Two additional patients, treated with similar methodology, are also described.
The preliminary experience with the described method shows the feasibility of a unique combination of the SEEG methodology with laser thermocoagulation in patients with neocortical MRI-negative pharmacoresistant focal epilepsy.
激光消融手术在治疗多种颅内疾病方面取得了令人鼓舞的效果，包括原发性和转移性脑肿瘤、放射性坏死和癫痫。立体脑电图（SEEG）方法与激光热凝治疗相结合，以调节新皮质无病变药物难治性癫痫患者的癫痫网络，以前尚未有报道。
描述与磁共振成像（MRI）阴性药物难治性新皮质局灶性癫痫患者的 SEEG 引导激光消融相关的新方法和新概念。
在先前的 SEEG 颅内数据的指导下，使用机器人引导装置将激光消融探针插入一名 17 岁的药物难治性癫痫患者，该患者癫痫发作难以定位，MRI 无病变。通过 MRI 确认激光应用器的位置，目标是左内侧额上回。在多平面数字成像视图和每个平面的实时热成像和治疗估计下进行消融。消融后的 MRI（对比 T1 序列）确认了消融的位置和大小。
整个过程大约需要 100 分钟。实际消融不到 3 分钟。大约术前 30 分钟用于定位和机器人注册。使用机器人引导实现了激光应用的精确放置（与计划的轨迹相比），并通过术中磁共振图像进行了确认。未报告任何并发症。术后患者无癫痫发作。随访期为 20 个月。还描述了另外两名采用类似方法治疗的患者。
所描述方法的初步经验表明，SEEG 方法与激光热凝相结合在新皮质 MRI 阴性药物难治性局灶性癫痫患者中具有可行性。
