Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA.
Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA.
Epilepsia. 2020 Aug;61(8):1723-1734. doi: 10.1111/epi.16614. Epub 2020 Aug 10.
Magnetic resonance imaging (MRI)-guided laser interstitial thermal therapy (MRg-LITT) is an alternative to open epilepsy surgery. We assess safety and effectiveness of MRg-LITT for extratemporal lobe epilepsy (ETLE) in patients who are considered less favorable for open resection.
We retrospectively reviewed sequential cases of patients with focal ETLE who underwent MRg-LITT between 2012 and 2019. Epileptogenic zones were determined from standard clinical and imaging data ± stereoelectroencephalography (SEEG). Standard stereotactic techniques, MRI thermometry, and a commercial laser thermal therapy system were used for ablations. Anatomic MRI was used to calculate ablation volumes. Clinical outcomes were determined longitudinally.
Thirty-five patients with mean epilepsy duration of 21.3 ± 12.2 years underwent MRg-LITT for focal ETLE at a mean age 36.4 ± 12.7 years. A mean 2.59 ± 1.45 trajectories per patient were used to obtain ablation volumes of 8.8 ± 7.5 cm . Mean follow-up was 27.3 ± 19.5 months. Of 32 patients with >12 months of follow-up, 17 (53%) achieved good outcomes (Engel class I + II) of whom 14 (44%) were Engel class I. Subgroup analysis revealed better outcomes for patients with lesional ETLE than for those who were nonlesional, multifocal, or who had failed prior interventions (P = .02). Of 13 patients showing favorable seizure-onset patterns (localized low voltage fast activity or rhythmic spiking on SEEG) prior to ablation, 9 (69%) achieved good outcomes, whereas only 3 of 11 (27%) who show other slower onset patterns achieved good outcomes. Minor adverse events included six patients with transient sensorimotor neurologic deficits and four patients with asymptomatic hemorrhages along the fiber tract. Major adverse events included one patient with a brain abscess that required stereotactic drainage and one patient with persistent hypothalamic obesity. Three deaths-two seizure-associated and one suicide-were unrelated to surgical procedures.
MRI-guided laser interstitial thermal therapy (or MRg-LITT) was well-tolerated and yielded good outcomes in a heterogeneous group of ETLE patients. Lesional epilepsy and favorable seizure-onset patterns on SEEG predicted higher likelihoods of success.
磁共振引导激光间质热疗（MRg-LITT）是开颅癫痫手术的一种替代方法。我们评估了在不太适合开颅切除的患者中，MRg-LITT 治疗外侧颞叶癫痫（ETLE）的安全性和有效性。
我们回顾性分析了 2012 年至 2019 年间接受 MRg-LITT 治疗的局灶性 ETLE 患者的连续病例。致痫区通过标准的临床和影像学数据确定，必要时结合立体脑电图（SEEG）。采用标准的立体定向技术、磁共振测温仪和商业激光热疗系统进行消融。解剖磁共振成像用于计算消融体积。采用纵向方法确定临床结果。
35 例 ETLE 平均病程 21.3±12.2 年的患者，平均年龄 36.4±12.7 岁，接受 MRg-LITT 治疗，每位患者平均使用 2.59±1.45 条轨迹，获得 8.8±7.5cm³的消融体积。平均随访时间为 27.3±19.5 个月。32 例有>12 个月随访的患者中，17 例（53%）达到良好结局（Engel Ⅰ+Ⅱ级），其中 14 例（44%）为 Engel Ⅰ级。亚组分析显示，有病变的 ETLE 患者比无病变、多灶性或先前干预失败的患者的结局更好（P=.02）。在消融前有 13 例患者出现有利的癫痫发作模式（局部低电压快速活动或 SEEG 上的节律性棘波），其中 9 例（69%）达到了良好的结局，而在 11 例显示其他较慢发作模式的患者中，仅有 3 例达到了良好的结局。轻微的不良事件包括 6 例短暂的感觉运动神经功能缺损和 4 例纤维束沿线无症状性出血。主要不良事件包括 1 例脑脓肿患者需要立体定向引流和 1 例持续性下丘脑肥胖。3 例死亡（2 例与癫痫相关，1 例自杀）与手术无关。
磁共振引导激光间质热疗（或 MRg-LITT）在一组异质性的 ETLE 患者中耐受性良好，且获得了良好的结果。病变性癫痫和 SEEG 上有利的癫痫发作模式预测更高的成功率。
