1Department of Neurosurgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London.
3Epilepsy Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.
J Neurosurg Pediatr. 2023 May 19;32(2):214-222. doi: 10.3171/2023.4.PEDS2318. Print 2023 Aug 1.
Robot-assisted (RA) stereotactic MRI-guided laser ablation has been reported to be a safe and effective technique for the treatment of epileptogenic foci in children and adults. In this study the authors aimed to assess the accuracy of RA stereotactic MRI-guided laser fiber placement in children and to identify factors that might increase the risk of misplacement.
A retrospective single-institution review of all children from 2019 to 2022 who underwent RA stereotactic MRI-guided laser ablation for epilepsy was undertaken. Placement error was calculated at the target by measuring the Euclidean distance between the implanted laser fiber position and the preoperatively planned position. Collected data included age at surgery, sex, pathology, date of robot calibration, number of catheters, entry position, entry angle, extracranial soft-tissue thickness, bone thickness, and intracranial catheter length. A systematic review of the literature was also performed using Ovid Medline, Ovid Embase, and the Cochrane Central Register of Controlled Trials.
In 28 children with epilepsy, the authors assessed 35 RA stereotactic MRI-guided laser ablation fiber placements. Twenty (71.4%) children had undergone ablation for hypothalamic hamartoma, 7 children (25.0%) for presumed insular focal cortical dysplasia, and 1 patient (3.6%) for periventricular nodular heterotopia. Nineteen children were male (67.9.%) and 9 were female (32.1%). The median age at the time of the procedure was 7.67 years (IQR 4.58-12.26 years). The median target point localization error (TPLE) was 1.27 mm (IQR 0.76-1.71 mm). The median offset error between the planned and actual trajectories was 1.04° (IQR 0.73°-1.46°). Patient age, sex, pathology and the time interval between date of surgery and robot calibration, entry position, entry angle, soft-tissue thickness, bone thickness, and intracranial length were not associated with the placement accuracy of the implanted laser fibers. However, the number of catheters placed did correlate with the offset angle error on univariate analysis (ρ = 0.387, p = 0.022). There were no immediate surgical complications. Meta-analysis indicated that the overall pooled mean TPLE was 1.46 mm (95% CI -0.58 to 3.49 mm).
RA stereotactic MRI-guided laser ablation for epilepsy in children is highly accurate. These data will aid surgical planning.
机器人辅助（RA）立体定向 MRI 引导激光消融已被报道为治疗儿童和成人致痫灶的一种安全有效的技术。在这项研究中，作者旨在评估 RA 立体定向 MRI 引导激光纤维放置在儿童中的准确性，并确定可能增加放置错误风险的因素。
回顾性分析了 2019 年至 2022 年间所有在我院接受 RA 立体定向 MRI 引导激光消融术治疗癫痫的儿童病例。通过测量植入激光纤维的位置与术前计划位置之间的欧几里得距离，计算目标处的放置误差。收集的数据包括手术时的年龄、性别、病理学、机器人校准日期、导管数量、进入位置、进入角度、颅外软组织厚度、骨厚度和颅内导管长度。还使用 Ovid Medline、Ovid Embase 和 Cochrane 中央对照试验注册中心进行了文献系统评价。
在 28 例癫痫儿童中，作者评估了 35 例 RA 立体定向 MRI 引导激光消融纤维放置。20 例（71.4%）儿童行下丘脑错构瘤消融术，7 例（25.0%）儿童行疑似岛叶局灶性皮质发育不良消融术，1 例（3.6%）行脑室周围结节性异位消融术。19 例为男性（67.9%），9 例为女性（32.1%）。手术时的中位年龄为 7.67 岁（IQR 4.58-12.26 岁）。中位靶点定位误差（TPLE）为 1.27mm（IQR 0.76-1.71mm）。计划轨迹与实际轨迹之间的中位偏移误差为 1.04°（IQR 0.73°-1.46°）。患者年龄、性别、病理学以及手术与机器人校准之间的时间间隔、进入位置、进入角度、软组织厚度、骨厚度和颅内长度与植入激光纤维的放置准确性无关。然而，在单因素分析中，放置的导管数量与偏移角度误差相关（ρ=0.387，p=0.022）。无即时手术并发症。荟萃分析表明，总体平均 TPLE 为 1.46mm（95%CI-0.58 至 3.49mm）。
RA 立体定向 MRI 引导激光消融治疗儿童癫痫非常准确。这些数据将有助于手术计划。
