磁共振引导下激光间质热疗术治疗药物难治性癫痫的操作规范_Journal of Epilepsy

Authors：

胡文瀚 ¹ , 柏建军 ² , 周文静 ² ,  张建国 ³ ,  张凯 ³

1. ;
2. ;
3. ;

Corresponding author：

张建国, Email: zjguo73@126.com; 张凯, Email: zhangkai62035@sina.com

Keywords：

DOI：

10.7507/2096-0247.202211008

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激光间质热疗术（Laser interstitial thermal therapy，LITT）由Bown于1983年首次描述， 1990年Sugiyama首次使用该术式治疗脑部病变，美国食品药品监督管理局（Food and Drug Administration，FDA）于2007年批准了LITT治疗颅内疾病，Curry等于2012年报道了磁共振引导下激光间质热疗术（MRI-guided laser interstitial thermal therapy，MgLITT）治疗癫痫。此后，MgLITT治疗癫痫得到了迅速的发展。来自论文的数据统计显示，世界范围内共有1800多例癫痫患者接受了MgLITT手术，涉及的病理包括下丘脑错构瘤（Hypothalamic hamartoma，HH）、颞叶内侧硬化、局灶性皮质发育不良（Focal cortical dysplasia，FCD）、各种发育性肿瘤、海绵状血管畸形等。依据诸多文献报道的结果，MgLITT治疗多种病理所致癫痫的疗效不劣于传统的开颅切除性手术，并以安全、准确、微创的优势，在未来可能改变癫痫外科的手术模式。目前已上市的MgLITT设备包括美国Medtronic公司的Visualase系统和加拿大Monteris公司的NeuroBlate系统，我国的Sinovation公司于2020年研制出国产MgLITT系统，同年完成动物实验并开始了上市前的临床试验。2020年8月12日北京天坛医院率先开展了MgLITT治疗一例颞叶内侧癫痫，截止到2022年5月，已完成230例MgLITT治疗不同病理类型癫痫的手术，初步积累了相关的经验。清华大学玉泉医院于2020年11月开始开展MgLITT治疗难治性癫痫患者，证实在非术中磁共振条件下也可安全有效的开展MgLITT治疗。中国抗癫痫协会谭启富基金管理委员会委托北京天坛医院和清华大学玉泉医院相关人员撰写MgLITT手术操作规范，从术前患者筛选、手术流程和术后管理等方面分别介绍，旨在助力于这一技术未来在中国的规范开展。

Citation： 胡文瀚, 柏建军, 周文静, 张建国, 张凯. 磁共振引导下激光间质热疗术治疗药物难治性癫痫的操作规范. Journal of Epilepsy, 2023, 9(1): 1-4. doi: 10.7507/2096-0247.202211008 Copy

1.	Bown SG. Phototherapy in tumors. World J Surg, 1983, 7(6): 700-709.
2.	Sugiyama K, Sakai T, Fujishima I, et al. Stereotactic interstitial laser-hyperthermia using Nd-YAG laser. Stereotact Funct Neurosurg, 1990, 54(55): 501-505.
3.	Curry DJ, Gowda A, McNichols RJ, et al. MR-guided stereotactic laser ablation of epileptogenic foci in children. Epilepsy Behav, 2012, 24(4): 408-414.
4.	Gross RE, Stern MA, Willie JT, et al. Stereotactic laser amygdalohippocampotomy for mesial temporal lobe epilepsy. Ann Neurol, 2018, 83(3): 575-587.
5.	Curry DJ, Raskin J, Ali I, et al. MR-guided laser ablation for the treatment of hypothalamic hamartomas. Epilepsy Res, 2018, 142: 131-134.
6.	Lewis EC, Weil AG, Duchowny M, et al. MR-guided laser interstitial thermal therapy for pediatric drug-resistant lesional epilepsy. Epilepsia, 2015, 56(10): 1590-1598.
7.	McCracken DJ, Willie JT, Fernald BA, et al. Magnetic resonance thermometry-guided stereotactic laser ablation of cavernous malformations in drug-resistant epilepsy: imaging and clinical results. Oper Neurosurg (Hagerstown), 2016, 12(1): 39-48.
8.	Patel NV, Frenchu K, Danish SF. Does the thermal damage estimate correlate with the magnetic resonance imaging predicted ablation size after laser interstitial thermal therapy? Oper Neurosurg （Hagerstown）, 2018, 15（2）: 179-183.
9.	Garcia-Medina O, Gorny K, McNichols R, et al. In vivo evaluation of a MR-guided 980nm laser interstitial thermal therapy system for ablations in porcine liver. Lasers Surg Med, 2011, 43(4): 298-305.
10.	McNichols RJ, Gowda A, Kangasniemi M, et al. MR thermometry-based feedback control of laser interstitial thermal therapy at 980 nm. Lasers Surg Med, 2004, 34(1): 48-55.
11.	McNichols RJ, Kangasniemi M, Gowda A, et al. Technical developments for cerebral thermal treatment: water-cooled diffusing laser fibre tips and temperature-sensitive MRI using intersecting image planes. Int J Hyperthermia, 2004, 20(1): 45-56.
12.	Wu C, Schwalb JM, Rosenow JM, et al. The American Society for Stereotactic and Functional Neurosurgery Position Statement on laser interstitial thermal therapy for the treatment of drug-resistant epilepsy. Neurosurgery, 2022, 90(2): 155-160.
13.	Kwan P, Arzimanoglou A, Berg A T, et al. Definition of drug resistant epilepsy: consensus proposal by the ad hoc Task Force of the ILAE Commission on Therapeutic Strategies. Epilepsia, 2010, 51(6): 1069-1077.
14.	Roland JL, Akbari SHA, Salehi A, et al. Corpus callosotomy performed with laser interstitial thermal therapy. J Neurosurg, 2019: 1-9.
15.	Liu Z, Hu W, Sun Z, et al. MRI abnormalities predominate in the bottom part of the sulcus with type ii focal cortical dysplasia: a quantitative study. AJNR Am J Neuroradiol, 2019, 40(1): 184-190.
16.	Hu W H, Zhao B T, Zhang C, et al. Focal cortical dysplasia II-related seizures originate from the bottom of the dysplastic sulcus: a stereoelectroencephalography study. Clin Neurophysiol, 2019, 130(9): 1596-1603.

1. Bown SG. Phototherapy in tumors. World J Surg, 1983, 7(6): 700-709.
2. Sugiyama K, Sakai T, Fujishima I, et al. Stereotactic interstitial laser-hyperthermia using Nd-YAG laser. Stereotact Funct Neurosurg, 1990, 54(55): 501-505.
3. Curry DJ, Gowda A, McNichols RJ, et al. MR-guided stereotactic laser ablation of epileptogenic foci in children. Epilepsy Behav, 2012, 24(4): 408-414.
4. Gross RE, Stern MA, Willie JT, et al. Stereotactic laser amygdalohippocampotomy for mesial temporal lobe epilepsy. Ann Neurol, 2018, 83(3): 575-587.
5. Curry DJ, Raskin J, Ali I, et al. MR-guided laser ablation for the treatment of hypothalamic hamartomas. Epilepsy Res, 2018, 142: 131-134.
6. Lewis EC, Weil AG, Duchowny M, et al. MR-guided laser interstitial thermal therapy for pediatric drug-resistant lesional epilepsy. Epilepsia, 2015, 56(10): 1590-1598.
7. McCracken DJ, Willie JT, Fernald BA, et al. Magnetic resonance thermometry-guided stereotactic laser ablation of cavernous malformations in drug-resistant epilepsy: imaging and clinical results. Oper Neurosurg (Hagerstown), 2016, 12(1): 39-48.
8. Patel NV, Frenchu K, Danish SF. Does the thermal damage estimate correlate with the magnetic resonance imaging predicted ablation size after laser interstitial thermal therapy? Oper Neurosurg （Hagerstown）, 2018, 15（2）: 179-183.
9. Garcia-Medina O, Gorny K, McNichols R, et al. In vivo evaluation of a MR-guided 980nm laser interstitial thermal therapy system for ablations in porcine liver. Lasers Surg Med, 2011, 43(4): 298-305.
10. McNichols RJ, Gowda A, Kangasniemi M, et al. MR thermometry-based feedback control of laser interstitial thermal therapy at 980 nm. Lasers Surg Med, 2004, 34(1): 48-55.
11. McNichols RJ, Kangasniemi M, Gowda A, et al. Technical developments for cerebral thermal treatment: water-cooled diffusing laser fibre tips and temperature-sensitive MRI using intersecting image planes. Int J Hyperthermia, 2004, 20(1): 45-56.
12. Wu C, Schwalb JM, Rosenow JM, et al. The American Society for Stereotactic and Functional Neurosurgery Position Statement on laser interstitial thermal therapy for the treatment of drug-resistant epilepsy. Neurosurgery, 2022, 90(2): 155-160.
13. Kwan P, Arzimanoglou A, Berg A T, et al. Definition of drug resistant epilepsy: consensus proposal by the ad hoc Task Force of the ILAE Commission on Therapeutic Strategies. Epilepsia, 2010, 51(6): 1069-1077.
14. Roland JL, Akbari SHA, Salehi A, et al. Corpus callosotomy performed with laser interstitial thermal therapy. J Neurosurg, 2019: 1-9.
15. Liu Z, Hu W, Sun Z, et al. MRI abnormalities predominate in the bottom part of the sulcus with type ii focal cortical dysplasia: a quantitative study. AJNR Am J Neuroradiol, 2019, 40(1): 184-190.
16. Hu W H, Zhao B T, Zhang C, et al. Focal cortical dysplasia II-related seizures originate from the bottom of the dysplastic sulcus: a stereoelectroencephalography study. Clin Neurophysiol, 2019, 130(9): 1596-1603.

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磁共振引导下激光间质热疗术治疗药物难治性癫痫的操作规范

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