J Korean Neurosurg Soc.  2019 May;62(3):353-360. 10.3340/jkns.2019.0105.

A Primer on Magnetic Resonance-Guided Laser Interstitial Thermal Therapy for Medically Refractory Epilepsy

Affiliations
  • 1Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.
  • 2Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University of Toronto, Toronto, Canada.
  • 3Krembil Research Institute, University Health Network, Toronto, Canada.
  • 4Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. hongsound@gmail.com

Abstract

Epilepsy surgery that eliminates the epileptogenic focus or disconnects the epileptic network has the potential to significantly improve seizure control in patients with medically intractable epilepsy. Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) has been an established option for epilepsy surgery since the US Food and Drug Administration cleared the use of MRgLITT in neurosurgery in 2007. MRgLITT is an ablative stereotactic procedure utilizing heat that is converted from laser energy, and the temperature of the tissue is monitored in real-time by MR thermography. Real-time quantitative thermal monitoring enables titration of laser energy for cellular injury, and it also estimates the extent of tissue damage. MRgLITT is applicable for lesion ablation in cases that the epileptogenic foci are localized and/or deep-seated such as in the mesial temporal lobe epilepsy and hypothalamic hamartoma. Seizure-free outcomes after MRgLITT are comparable to those of open surgery in well-selected patients such as those with mesial temporal sclerosis. Particularly in patients with hypothalamic hamartoma. In addition, MRgLITT can also be applied to ablate multiple discrete lesions of focal cortical dysplasia and tuberous sclerosis complex without the need for multiple craniotomies, as well as disconnection surgery such as corpus callosotomy. Careful planning of the target, the optimal trajectory of the laser probe, and the appropriate parameters for energy delivery are paramount to improve the seizure outcome and to reduce the complication caused by the thermal damage to the surrounding critical structures.

Keyword

Drug resistant epilepsy; Hypothalamic hamartomas; Laser therapy; Anterior temporal lobectomy; Epilepsy, Temporal lobe

MeSH Terms

Anterior Temporal Lobectomy
Craniotomy
Drug Resistant Epilepsy
Epilepsy*
Epilepsy, Temporal Lobe
Hamartoma
Hot Temperature
Humans
Laser Therapy
Malformations of Cortical Development
Neurosurgery
Sclerosis
Seizures
Thermography
Tuberous Sclerosis
United States Food and Drug Administration

Figure

  • Fig. 1. Schematic illustration showing the workflow of the magnetic resonance-guided laser interstitial thermal therapy 5,14 Figures are modified with permission for use from Medtronic.

  • Fig. 2. Schematic depicting the target and the trajectory of laser probe for magnetic resonance-guided laser interstitial thermal therapy in patients with mesial temporal lobe epilepsy. Note the anatomical relationships between the ventricle (blue), hippocampus (green), and amygdala (pink). A : Sagittal view. B : Axial view.


Reference

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