Gupta Kunal, Dickey Adam S, Hu Ranliang, Faught Edward, Willie Jon T
Department of Neurosurgery, Emory University Hospital, Atlanta, GA, United States.
Department of Neurosurgery, Indiana University Health, Indianapolis, IN, United States.
Front Neurol. 2020 Nov 27;11:572334. doi: 10.3389/fneur.2020.572334. eCollection 2020.
Robotic systems have fundamentally altered the landscape of functional neurosurgery. These allow automated stereotaxy with high accuracy and reliability, and are rapidly becoming a mainstay in stereotactic surgeries such as deep brain stimulation (DBS), stereoelectroencephalography (SEEG), and stereotactic laser ablation/MRI guided laser interstitial thermal therapy (MRgLITT). Robotic systems have been effectively applied to create a minimally invasive approach for diagnostics and therapeutics in the treatment of epilepsy, utilizing robots for expeditious and accurate stereotaxy for SEEG and MRgLITT. MRgLITT has been shown to approach open surgical techniques in efficacy of seizure control while minimizing collateral injury. We describe the use of robot assisted MRgLITT for a minimally invasive laser anterior temporal lobotomy, describing the approach and potential pitfalls. Goals of MRgLITT are complete ablation of the epileptogenic zone and avoiding injury to uninvolved structures. In the middle fossa these include structures such as cranial nerves in the skull base and cavernous sinus and the thalamus. These can be mitigated with careful trajectory planning and control of laser ablation intensity.
机器人系统已从根本上改变了功能神经外科的格局。这些系统可实现高精度和高可靠性的自动立体定位，并且正迅速成为立体定向手术（如脑深部电刺激（DBS）、立体脑电图（SEEG）以及立体定向激光消融/磁共振成像引导激光间质热疗（MRgLITT））的主要手段。机器人系统已被有效地应用于为癫痫治疗创建一种微创诊断和治疗方法，利用机器人进行快速且精确的立体定位以用于SEEG和MRgLITT。已证明MRgLITT在控制癫痫发作的疗效上可接近开放性手术技术，同时将附带损伤降至最低。我们描述了使用机器人辅助MRgLITT进行微创激光前颞叶切除术的方法及潜在陷阱。MRgLITT的目标是完全消融致痫区并避免损伤未受累结构。在中颅窝，这些结构包括颅底和海绵窦中的颅神经以及丘脑等。通过仔细的轨迹规划和控制激光消融强度可减轻这些风险。
