Carminucci Arthur, Patel Nitesh V, Sundararajan Sri, Keller Irwin, Danish Shabbar
Neurosurgery, Rutgers Robert Wood Johnson Medical School, Piscataway, USA.
Radiology, Rutgers Robert Wood Johnson Medical School, Piscataway, USA.
Cureus. 2018 Mar 27;10(3):e2376. doi: 10.7759/cureus.2376.
Magnetic resonance (MR)-guided stereotactic laser amygdalohippocampectomy is a minimally invasive procedure for the treatment of refractory epilepsy in patients with mesial temporal sclerosis. Limited data exist on post-ablation volumetric trends associated with the procedure.
10 patients with mesial temporal sclerosis underwent MR-guided stereotactic laser amygdalohippocampectomy. Three independent raters computed ablation volumes at the following time points: pre-ablation (PreA), immediate post-ablation (IPA), 24 hours post-ablation (24PA), first follow-up post-ablation (FPA), and greater than three months follow-up post-ablation (>3MPA), using OsiriX DICOM Viewer (Pixmeo, Bernex, Switzerland). Statistical trends in post-ablation volumes were determined for the time points.
MR-guided stereotactic laser amygdalohippocampectomy produces a rapid rise and distinct peak in post-ablation volume immediately following the procedure. IPA volumes are significantly higher than all other time points. Comparing individual time points within each raters dataset (intra-rater), a significant difference was seen between the IPA time point and all others. There was no statistical difference between the 24PA, FPA, and >3MPA time points. A correlation analysis demonstrated the strongest correlations at the 24PA (r=0.97), FPA (r=0.95), and 3MPA time points (r=0.99), with a weaker correlation at IPA (r=0.92).
MR-guided stereotactic laser amygdalohippocampectomy produces a maximal increase in post-ablation volume immediately following the procedure, which decreases and stabilizes at 24 hours post-procedure and beyond three months follow-up. Based on the correlation analysis, the lower inter-rater reliability at the IPA time point suggests it may be less accurate to assess volume at this time point. We recommend post-ablation volume assessments be made at least 24 hours post-selective ablation of the amygdalohippocampal complex (SLAH).
磁共振（MR）引导下立体定向激光杏仁核海马切除术是治疗内侧颞叶硬化症患者难治性癫痫的一种微创手术。关于该手术后消融体积变化趋势的数据有限。
10例内侧颞叶硬化症患者接受了MR引导下立体定向激光杏仁核海马切除术。三名独立评估者使用OsiriX DICOM Viewer（瑞士伯尔尼的Pixmeo公司）在以下时间点计算消融体积：消融前（PreA）、消融后即刻（IPA）、消融后24小时（24PA）、消融后首次随访（FPA）以及消融后三个月以上随访（>3MPA）。确定各时间点消融后体积的统计趋势。
MR引导下立体定向激光杏仁核海马切除术在术后即刻会使消融后体积迅速增加并出现明显峰值。IPA时的体积显著高于所有其他时间点。在每个评估者的数据集中比较各个时间点（评估者内部），IPA时间点与所有其他时间点之间存在显著差异。24PA、FPA和>3MPA时间点之间无统计学差异。相关性分析显示，在24PA（r = 0.97）、FPA（r = 0.95）和3MPA时间点（r = 0.99）相关性最强，在IPA时相关性较弱（r = 0.92）。
MR引导下立体定向激光杏仁核海马切除术在术后即刻会使消融后体积最大程度增加，在术后24小时及三个月以上随访时体积减小并稳定。基于相关性分析，IPA时间点评估者间可靠性较低，表明此时评估体积可能不太准确。我们建议在选择性消融杏仁核海马复合体（SLAH）后至少24小时进行消融后体积评估。
