摘要
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.
作者
胡文瀚
莫嘉杰
刘畅
王秀
刘焕光
赵宝田
邱佳冀
高冬梅
邵晓秋
张建国
张凯
Hu Wenhan;Mo Jiajie;Liu Chang;Wang Xiu;Liu Huanguang;Zhao Baotian;Qiu Jiaji;Gao Dongmei;Shao Xiaoqiu;Zhang Jianguo;Zhang Kai(Department of Neurosurgery,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China;Beijing Neurosurgical Institute,Capital Medical University,Beijing 100070,China;Department of Neurology,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China)
出处
《中华神经外科杂志》
CSCD
北大核心
2021年第8期764-770,共7页
Chinese Journal of Neurosurgery
基金
国家重点研发计划(2018YFC00115401)
国家自然科学基金(82071457,81771399)
首都卫生发展科研专项(2020-2-1076)。
关键词
癫痫
磁共振成像
激光间质热疗
实时温度监测
治疗结果
Epilepsy
Magnetic resonance imaging
Laser interstitial thermal therapy
Real-time thermal monitoring
Treatment outcome