The use of MRI-guided laser-induced thermal ablation for epilepsy

Childs Nerv Syst. 2013 Nov;29(11):2089-94. doi: 10.1007/s00381-013-2169-6. Epub 2013 Jun 4.

Abstract

Purpose: Epilepsy surgery is constantly researching for new options for patients with refractory epilepsy. MRI-guided laser-induced thermal ablation for epilepsy is an exciting new minimally invasive technology with an emerging use for lesionectomy of a variety of epileptogenic focuses (hypothalamic hamartomas, cortical dysplasias, cortical malformations, tubers) or as a disconnection tool allowing a new option of treatment without the hassles of an open surgery.

Methods: MRI-guided laser interstitial thermal therapy (MRgLITT) is a procedure for destroying tissue-using heat. To deliver this energy in a minimally invasive fashion, a small diameter fiber optic applicator is inserted into the lesion through a keyhole stereotactic procedure. The thermal energy induces damage to intracellular DNA and DNA-binding structures, ultimately leading to cell death. The ablation procedure is supervised by real-time MRI thermal mapping and confirmed by immediate post-ablation T1 or FLAIR MRI images.

Results: The present report includes an overview of the development and practice of an MR-guided laser ablation therapy known as MRI-guided laser interstitial thermal therapy (MRgLITT). The role of modern image-guided trajectory planning in MRgLITT will also be discussed, with particular emphasis on the treatment of refractory epilepsy using this novel, minimally invasive technique.

Conclusion: MRI-guided laser-induced thermal ablation for epilepsy is an exciting new minimally invasive technology that finds potential new applications every day in the neurosurgical field. It certainly brings a new perspective on the way we practice epilepsy surgery even though long-term results should be properly collected and analyzed.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Ablation Techniques / instrumentation
  • Ablation Techniques / methods*
  • Child
  • Epilepsy / surgery*
  • Humans
  • Laser Therapy / instrumentation
  • Laser Therapy / methods*
  • Magnetic Resonance Imaging / instrumentation
  • Magnetic Resonance Imaging / methods*
  • Male
  • Neurosurgical Procedures / instrumentation
  • Neurosurgical Procedures / methods*
  • Surgery, Computer-Assisted / instrumentation
  • Surgery, Computer-Assisted / methods*