Yousefi Omid, Sabahi Mohammadmahdi, Malcolm James, Adada Badih, Borghei-Razavi Hamid
Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.
Neurosurgery Research Group (NRG), Student Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran.
Front Surg. 2022 May 13;9:887329. doi: 10.3389/fsurg.2022.887329. eCollection 2022.
Microsurgical resection of intracranial cavernous malformations (CM) is regarded as the standard treatment, but in recent years, there has been a trend toward minimally invasive procedures like ablation of such lesions by using laser interstitial thermal therapy (LITT).
A systematic search using keywords 'laser interstitial thermal therapy' OR 'LITT' AND 'cavernoma' OR 'cavernous angiomas' OR 'cavernous malformations' was conducted in MEDLINE (PubMed), Scopus, Embase, and Cochrane electronic bibliographic databases and studies reporting the outcome of LITT procedure on intracranial CM were included. The demographic data, symptoms of patients, location and size of the lesion, and surgical outcome were extracted from the articles.
Six studies, reporting the outcome of 33 patients were included in this review. In 26 patients, CM was identified as the epileptogenic foci and in others, CM was the source of headache or focal neurological deficits. LITT led to a satisfactory outcome in all patients except for three who achieved improvement in symptoms after the open resection of the lesion. Most of the post-operative complications were transient and resolved at the time of the last follow up. Cyst formation at the previous ablated CM site was reported as the long-term complication of LITT in one case.
LITT can provide a comparable outcome to the open resection of CMs, by having less invasiveness, even in deep and eloquent area lesions, and complications that are often temporary and disappear gradually. However, technical issues, such as thermal monitoring during the procedure, are considered a challenge for this procedure in CMs. Further studies with a larger population are needed to report this method's long-term outcome and complications on CMs.
颅内海绵状畸形（CM）的显微手术切除被视为标准治疗方法，但近年来，出现了一种采用激光间质热疗（LITT）等微创方法消融此类病变的趋势。
在MEDLINE（PubMed）、Scopus、Embase和Cochrane电子文献数据库中使用关键词“激光间质热疗”或“LITT”以及“海绵状瘤”或“海绵状血管瘤”或“海绵状畸形”进行系统检索，并纳入报告LITT治疗颅内CM结果的研究。从文章中提取患者的人口统计学数据、症状、病变的位置和大小以及手术结果。
本综述纳入了6项报告33例患者结果的研究。在26例患者中，CM被确定为致痫灶，在其他患者中，CM是头痛或局灶性神经功能缺损的来源。除3例在病变开放切除后症状有所改善的患者外，LITT在所有患者中均取得了满意的结果。大多数术后并发症是短暂的，在最后一次随访时得到缓解。1例报告显示，先前消融的CM部位形成囊肿是LITT的长期并发症。
LITT可以提供与CM开放切除相当的结果，具有更小的侵入性，即使在深部和功能区病变中也是如此，并且并发症通常是暂时的并会逐渐消失。然而，术中热监测等技术问题被认为是CM治疗中该方法面临的挑战。需要对更多人群进行进一步研究，以报告该方法对CM的长期结果和并发症。
