magnetic_resonance_guided_laser_induced_thermal_therapy_for_epilepsy

Magnetic resonance guided laser induced thermal therapy for epilepsy

MRgLITT offers access to foci virtually anywhere in the brain with minimal disruption of the overlying cortex and white matter, promising fewer neurological side effects and less surgical morbidity and pain. Compared to other ablative techniques, MRgLITT offers immediate, discrete lesions with real-time monitoring of temperature beyond the fiber tip for damage estimates and off-target injury prevention. Applications of MRgLITT for epilepsy are growing rapidly and, although more evidence of safety and efficacy is needed, there are potential advantages for some patients 1).


It has been used for selective amygdalohippocampectomy ablation for the treatment of temporal lobe epilepsy.

see also Stereotactic laser amygdalohippocampotomy.

Magnetic resonance guided laser induced thermal therapy for epilepsy is an exciting new minimally invasive technique that finds potential new applications every day in the neurosurgical field. It certainly brings a new perspective on the way we practice epilepsy surgery even though long-term results should be properly collected and analyzed 2).


The report of Willie et al., demonstrates the technical feasibility and encouraging early results of stereotactic laser amygdalohippocampotomy (SLAH), a novel approach to eliminating seizures while minimizing collateral injury in patients with MTLE. Efficacy appears to approach that of open resection, especially in patients with MTS. Such minimally invasive techniques may be more desirable to patients and result in increased use of epilepsy surgery among the large number of medically intractable epilepsy patients. A larger, longer term multicenter study of seizure and cognitive outcomes after SLAH is currently under way 3).


Treatment of medication-resistant epilepsy that accomplishes ablation of the seizure focus with real-time magnetic resonance thermal mapping. Rates of seizure freedom in early series suggest that SLA approaches and perhaps surpasses the effectiveness of open resection. SLA minimizes the neurocognitive and endocrine adverse effects of open surgery. Secondary benefits of SLA include decreased length of stay, elimination of intensive care unit stay, reduced procedure-related discomfort, and improved access to surgical treatment for patients less likely to consider an open resective procedure 4).

Magnetic resonance guided laser induced thermal therapy for epilepsy case series.

Magnetic resonance guided laser induced thermal therapy for epilepsy case reports


1)
Youngerman BE, Save AV, McKhann GM. Magnetic Resonance Imaging-Guided Laser Interstitial Thermal Therapy for Epilepsy: Systematic Review of Technique, Indications, and Outcomes. Neurosurgery. 2020 Jan 24. pii: nyz556. doi: 10.1093/neuros/nyz556. [Epub ahead of print] PubMed PMID: 31980831.
2)
Tovar-Spinoza Z, Carter D, Ferrone D, Eksioglu Y, Huckins S. The use of MRI-guided laser-induced thermal ablation for epilepsy. Childs Nerv Syst. 2013 Nov;29(11):2089-94. doi: 10.1007/s00381-013-2169-6. Epub 2013 Jun 4. Review. PubMed PMID: 23732793.
3)
Willie JT, Laxpati NG, Drane DL, Gowda A, Appin C, Hao C, Brat DJ, Helmers SL, Saindane A, Nour SG, Gross RE. Real-time magnetic resonance-guided stereotactic laser amygdalohippocampotomy for mesial temporal lobe epilepsy. Neurosurgery. 2014 Jun;74(6):569-85. doi: 10.1227/NEU.0000000000000343. PubMed PMID: 24618797.
4)
Rolston JD, Chang EF. Stereotactic Laser Ablation for Hypothalamic Hamartoma. Neurosurg Clin N Am. 2016 Jan;27(1):59-67. doi: 10.1016/j.nec.2015.08.007. Epub 2015 Oct 24. Review. PubMed PMID: 26615108.
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