The use of MRI-guided laser-induced thermal ablation for epilepsy
- 1.3k Downloads
Epilepsy surgery is constantly researching for new options for patients with refractory epilepsy. MRI-guided laser-induced thermal ablation for epilepsy is an exciting new minimally invasive technology with an emerging use for lesionectomy of a variety of epileptogenic focuses (hypothalamic hamartomas, cortical dysplasias, cortical malformations, tubers) or as a disconnection tool allowing a new option of treatment without the hassles of an open surgery.
MRI-guided laser interstitial thermal therapy (MRgLITT) is a procedure for destroying tissue-using heat. To deliver this energy in a minimally invasive fashion, a small diameter fiber optic applicator is inserted into the lesion through a keyhole stereotactic procedure. The thermal energy induces damage to intracellular DNA and DNA-binding structures, ultimately leading to cell death. The ablation procedure is supervised by real-time MRI thermal mapping and confirmed by immediate post-ablation T1 or FLAIR MRI images.
The present report includes an overview of the development and practice of an MR-guided laser ablation therapy known as MRI-guided laser interstitial thermal therapy (MRgLITT). The role of modern image-guided trajectory planning in MRgLITT will also be discussed, with particular emphasis on the treatment of refractory epilepsy using this novel, minimally invasive technique.
MRI-guided laser-induced thermal ablation for epilepsy is an exciting new minimally invasive technology 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.
KeywordsLaser ablation MRI guided Epilepsy
- 3.Fine S, Klein E, Nowak W, Scott R, Laor Y, Simpson L, Crissey J, Donaghue J, Dehr U (1965) Interaction of laser radiation with biologic systems: I Studies on interaction with tissues. Fed Proc 24Google Scholar
- 7.Stellar S, Polayni T, Bredemeier H (1971) Lasers in surgery. In: Wolbarsht M (ed) Laser application in biology and medicine. Plenum, New YorkGoogle Scholar
- 8.Stellar S, Polayni T, Bredemeier H (1974) Lasers in surgery. In: Wolbarsht M (ed) Laser applications in biology and medicine. Plenum, New YorkGoogle Scholar
- 9.Heppner F (1978) The laser scalpel on the nervous system. In: Kaplan I (ed) Laser surgery II. Jerusalem Academic Press, Jerusalem, pp 28–30Google Scholar
- 11.Heppner F (1979) [Experiences with the CO2 laser in surgery of the nervous system]. Zentralblatt fur Neurochirurgie 40: 297–301, 303–294Google Scholar
- 12.Takizawa T, Yamazaki T, Miura N, Matsumoto M, Tanaka Y, Takeuchi K, Nakata Y, Togashi O, Nagai M, Ariga T, Nishimura T, Mizutani H, Sano K (1980) Laser surgery of basal, orbital and ventricular meningiomas which are difficult to extirpate by conventional methods. Neurol Med Chir 20:729–737CrossRefGoogle Scholar
- 15.Fan M, Ascher P, Germann R, Ebner F (1992) Temperature profiles of interstitial 1.06 Nd:YAG laserthermia in human cadaver brain. In: Spinelli P, Dal Fante M, Marchesini R (eds) Photodynamic therapy and biomedical lasers. Elsevier Science, Amsterdam, pp 349–353Google Scholar
- 25.Jethwa PR, Barrese JC, Gowda A, Shetty A, Danish SF (2012) Magnetic resonance thermometry-guided laser-induced thermal therapy for intracranial neoplasms: initial experience. Neurosurgery 71(133–144):144–135Google Scholar
- 27.Carpentier A, McNichols RJ, Stafford RJ, Itzcovitz J, Guichard JP, Reizine D, Delaloge S, Vicaut E, Payen D, Gowda A, George B (2008) Real-time magnetic resonance-guided laser thermal therapy for focal metastatic brain tumors. Neurosurgery 63:ONS21–ONS28. doi:10.1227/01.neu.0000335007.07381.df, discussion ONS28-29PubMedCrossRefGoogle Scholar
- 30.van Gemert M, Welch A (eds) (1995) Optical–thermal response of laser-irradiated tissue. Springer, New York. ISBN 0306449269Google Scholar
- 31.Tracz RA, Wyman DR, Little PB, Towner RA, Stewart WA, Schatz SW, Wilson BC, Pennock PW, Janzen EG (1993) Comparison of magnetic resonance images and the histopathological findings of lesions induced by interstitial laser photocoagulation in the brain. Lasers Surg Med 13:45–54PubMedCrossRefGoogle Scholar