71 MRI-Guided Laser Thermal Therapy in Pediatric Epilepsy Surgery

摘要

MRI-guided laser-induced thermal therapy (MRIgLITT) is a novel minimally invasive option for treatment of epilepsy in well-selected cases. LITT uses heat to generate ablation by means of tissue light absorption. MRIgLITT is applied under general anesthesia through a single twist drill hole. The laser probe is then positioned and delivered to the target using frameless, robotic, or traditional frame-based stereotaxis. The heat delivery is monitored in real time via MR thermography as explained earlier until obtaining the desired ablation. MRIgLITT procedure can be performed under local anesthesia, moderate sedation, or general anesthesia. Ablation is an option as initial, subsequent, or repeated treatment, as an adjuvant to other therapies, given that it has no dose limitations. The evidence of seizure-free outcome using MRIgLITT in pediatric epilepsy is limited to a few reports with short follow-up. Nevertheless, the adult publications are encouraging to adopt this technology and consider it as the first option in drug-resistant epilepsy in patients with mesial temporal sclerosis, hypothalamic hamartomas, cortical dysplasias (including insular lesions), corpus callosotomy, tuberous sclerosis complex, periventricular heterotopias, and tumors.