磁共振引导激光间质热疗治疗药物难治性癫痫的手术策略及疗效

Surgical strategy and outcome of magnetic resonance-guided laser interstitial thermal therapy for the treatment of drug-resistant epilepsy

目的探讨磁共振引导激光间质热疗(MRgLITT)治疗药物难治性癫痫的手术策略及临床疗效。方法回顾性分析2020年8—9月首都医科大学附属北京天坛医院神经外科经MRgLITT治疗的15例药物难治性癫痫患者的临床资料。病变包括颅内肿瘤2例、下丘脑错构瘤2例、海马硬化4例、局灶性皮质发育不良3例、灰质异位症2例、颅内海绵状血管畸形1例和双侧枕叶软化(行胼胝体切开术)1例。患者术前均经多学科评估。术后评价指标包括消融体积比率、消融有效率以及术后3个月的癫痫无发作率、癫痫发作降低率和并发症的发生情况等。结果15例患者的MRgLITT治疗均顺利完成。计划消融体积为785.4~10716.0 mm^(3),实际消融体积为851.4~14717.8 mm^(3),消融体积比率为91.2%~98.1%,消融有效率为100%,消融时间为136~6345 s。其中2例患者术后出现并发症,均为轻度出血,后期恢复良好。15例患者术后的住院时间为3~6 d。15例患者术后3个月的随访结果显示,8例无癫痫发作,3例癫痫发作减少>50%,3例癫痫发作减少<50%,1例癫痫发作无变化。结论临床应用MRgLITT应严格筛选适应证,术中通过结合立体定向、实时温度监测等技术,以及合理规划光纤路径和毁损范围,可安全、有效地毁损致痫灶。

Objective To explore the surgical strategy and clinical efficacy of magnetic resonance-guided laser interstitial thermal therapy(MRgLITT)for the treatment of drug-resistant epilepsy.Methods A retrospective analysis was conducted on the clinical data of 15 patients with drug-resistant epilepsy treated by MRgLITT at the Department of Neurosurgery,Beijing Tiantan Hospital,Capital Medical University from August to September 2020.Lesions included 2 cases of intracranial tumors,2 cases of hypothalamic hamartoma,4 cases of hippocampal sclerosis,3 cases of focal cortical dysplasia,2 cases of gray matter heterotopia,1 case of intracranial cavernous malformation,and 1 case of bilateral occipital lobe gliosis which underwent corpus callosotomy.All patients underwent multidisciplinary evaluation before operation.Postoperative assessment included ablation volume ratio,effective rate of ablation,seizure-free rate,seizure reduction rate,and complication rate at 3 months after surgery.Results The MRgLITT treatment of 15 patients was successfully completed with satisfactory results.The planned ablation volume was 785.4-10716.0 mm^(3),the actual ablation volume was 851.4-14717.8 mm^(3),the actual/planned ablation volume ratio was 91.2%-98.1%;the effective rate of ablation was 100%;the ablation time was 136-6345 s.Two of the patients had postoperative complications,both of which had mild bleeding and recovered well.The postoperative hospital stay of 15 patients was 3 to 6 days.The results of follow-up of 15 patients for 3 months after operation showed that 8 cases remained seizure free,seizures were reduced by more than 50%in 3 cases,seizures were reduced by less than 50%in 3 cases,and seizures remained unchanged in 1 case.Conclusions The clinical application of MRgLITT should be strictly screened for indications.Intraoperative techniques such as stereotactic method,real-time temperature monitoring and laser thermal therapy,as well as reasonable planning of the laser fiber trajectory and lesioning range,can be applied to safely and effectively ablate the epileptic foci.