Hect Jasmine L, Alattar Ali A, Harford Emily E, Reecher Hope, Fernandes David T, Esplin Nathan, McDowell Michael, Abel Taylor J
Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, USA.
Department of Neurosurgery, Allegheny Health Network, Pittsburgh, USA.
Childs Nerv Syst. 2022 May;38(5):961-970. doi: 10.1007/s00381-022-05491-x. Epub 2022 Mar 11.
MRI-guided laser interstitial thermal therapy (MRgLITT) is a promising alternative to open surgery for treatment of drug-resistant epilepsy, offering significant advantages over traditional approaches for candidate patients, including minimally invasive approach, shorter hospitalization, and decreased patient post-operative discomfort. LITT uses a stereotactically placed fiber optic laser probe to ablate tissue under real-time MR thermometry.
Retrospective chart review of intraoperative and perioperative characteristics was performed for 28 cases of MRgLITT in 25 pediatric patients, ages 4-21 years old, at our institution between 2019 and 2021. MRgLITT ablation of the mesial temporal lobe was performed in 8 cases, extratemporal epileptogenic foci in 9 cases, and for corpus callosotomy in 11 cases.
At 1 year of follow-up, 53% of all patients experienced improvement in seizure frequency (Engel I or II) (class I: 38%, class II: 15%, class III: 17%, class IV: 31%), including 37% of MTL ablations and 80% extratemporal SOZ ablations. After MRgLITT corpus callosotomy, 71% of patients were free from atonic seizures at most recent follow-up. Median length of hospitalization was 2 days (1-3), including a median ICU stay of 1 day (1-2).
This series demonstrates the safety of MRgLITT as an approach for seizure control in drug-resistant epilepsy. We provide additional evidence that MRgLITT is an effective procedure that is well-tolerated by pediatric patients and is accompanied by an acceptable rate of complications and relatively short hospital stay.
磁共振成像引导下的激光间质热疗（MRgLITT）是治疗耐药性癫痫的一种有前景的开放性手术替代方法，对于候选患者而言，它比传统方法具有显著优势，包括微创方法、住院时间短以及患者术后不适减轻。LITT使用立体定向放置的光纤激光探头在实时磁共振测温下消融组织。
对2019年至2021年期间在我们机构接受MRgLITT治疗的25例4至21岁儿科患者的28例病例进行了术中及围手术期特征的回顾性图表分析。其中8例进行了内侧颞叶的MRgLITT消融，9例进行了颞外致痫灶消融，11例进行了胼胝体切开术。
在1年的随访中，所有患者中有53%的癫痫发作频率得到改善（Engel I或II级）（I级：38%，II级：15%，III级：17%，IV级：31%），包括37%的内侧颞叶消融和80%的颞外致痫灶消融。在进行MRgLITT胼胝体切开术后，71%的患者在最近一次随访时无失张力发作。住院时间中位数为2天（1 - 3天），其中重症监护病房（ICU）停留时间中位数为1天（1 - 2天）。
本系列研究证明了MRgLITT作为控制耐药性癫痫发作方法的安全性。我们提供了更多证据表明，MRgLITT是一种有效的手术方法，儿科患者耐受性良好，并发症发生率可接受，住院时间相对较短。
