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Stereotaktische Laserthermokoagulation in der Epilepsiechirurgie

Stereotactic laser thermocoagulation in epilepsy surgery

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Zusammenfassung

Neben anderen stereotaktischen Verfahren verspricht die stereotaktische Laserthermokoagulation (SLT) eine schonende Ausschaltung pathologischen Gewebes. Dies dürfte zukünftig besonders für die Epilepsiechirurgie von Bedeutung sein. Gegenüber kraniellen Standardeingriffen entfällt die großflächige Kraniotomie, kortikale Schädigungen im Zugangsweg zu tief liegenden Läsionen können vermieden werden und Eingriffe in der Nähe eloquenter Hirnareale werden möglich. Wir beschreiben hier den historischen Hintergrund und das Rationale der Laserneurochirurgie und stellen die beiden verfügbaren Verfahren vor (Visualase®, NeuroBlate®; CE-Kennzeichnungen stehen noch aus). Neuartig ist die Kopplung mit MR-Bildgebung und MR-Thermometrie, durch die eine höhere Anwendungssicherheit gewährleistet werden soll. Wir berichten die klinischen Erfahrungen mit SLT in der Epilepsiechirurgie, soweit sie in kleinen Studien und Fallserien publiziert sind (ca. 200 Patienten), hinsichtlich Komplikationen, hirnstruktureller Veränderungen, Anfallsoutcome, neuropsychologischer Therapieergebnisse und Behandlungskosten. Die Rate anfallsfreier Patienten liegt etwas niedriger als bei resektiven Eingriffen. Aufgrund nicht hinreichender Studienqualität konnte ein Vorteil hinsichtlich des neuropsychologischen Outcomes bisher noch nicht überzeugend aufgezeigt werden.

Abstract

In common with other stereotactic procedures, stereotactic laser thermocoagulation (SLT) promises gentle destruction of pathological tissue, which might become especially relevant for epilepsy surgery in the future. Compared to standard resection, no large craniotomy is necessary, cortical damage during access to deep-seated lesions can be avoided and interventions close to eloquent brain areas become possible. We describe the history and rationale of laser neurosurgery as well as the two available SLT systems (Visualase® and NeuroBlate®; CE marks pending). Both systems are coupled with magnetic resonance imaging (MRI) and MR thermometry, thereby increasing patient safety. We report the published clinical experiences with SLT in epilepsy surgery (altogether approximately 200 cases) with respect to complications, brain structural alterations, seizure outcome, neuropsychological findings and treatment costs. The rate of seizure-free patients seems to be slightly lower than for resection surgery. Due to the inadequate quality of studies, the neuropsychological superiority of SLT has not yet been unambiguously demonstrated.

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Authors and Affiliations

  1. Klinik für Epileptologie, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Deutschland

    C. Hoppe, J.-A. Witt, C. Helmstaedter & C. E. Elger

  2. Klinik für Neurochirurgie, Beta Klinik, Bonn, Deutschland

    T. Gasser

  3. Neurochirurgische Klinik, Universitätsklinikum Bonn, Bonn, Deutschland

    H. Vatter

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  1. C. Hoppe
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  2. J.-A. Witt
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  3. C. Helmstaedter
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  4. T. Gasser
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  6. C. E. Elger
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Correspondence to C. Hoppe.

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C. Hoppe, J.-A. Witt, C. Helmstaedter, T. Gasser, H. Vatter und C. E. Elger geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Hoppe, C., Witt, JA., Helmstaedter, C. et al. Stereotaktische Laserthermokoagulation in der Epilepsiechirurgie. Nervenarzt 88, 397–407 (2017). https://doi.org/10.1007/s00115-017-0283-5

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