无MRI兼容手术室条件下开展MRI引导下激光间质热疗治疗局灶性癫痫的安全性和有效性

doi:10.19854/j.cnki.1008-2425.2025.03.0002

立体定向和功能性神经外科杂志 ›› 2025, Vol. 38 ›› Issue (3): 135-143.DOI: 10.19854/j.cnki.1008-2425.2025.03.0002

无MRI兼容手术室条件下开展MRI引导下激光间质热疗治疗局灶性癫痫的安全性和有效性

柏建军, 范婷, 林久銮, 于翠萍, 张冰清, 王海祥, 丰倩, 宋宪成, 史洁, 刘一鸥, 孙朝晖, 贺晶, 阮静, 李佳, 周文静

100040 北京清华大学玉泉医院(清华大学中西医结合医院)癫痫中心

收稿日期:2025-05-12 出版日期:2025-06-25 发布日期:2025-12-25
通讯作者: 周文静 closejeo@hotmail.com
基金资助:
北京市科技计划项目(编号:Z231100004823035)

Safety and Efficacy of Magnetic Resonance-Guided Laser Interstitial Thermal Therapy for Focal Epilepsy in a Non-Magnetic Resonance-Compatible Operating Room Setting

Bai Jianjun, Fan Ting, Lin Jiuluan, Yu Cuiping, Zhang Bingqing, Wang Haixiang, Song Xiancheng, Shi Jie, Liu Yiou, Sun Zhaohui, He Jing, Ruan Jing, Li Jia, Zhou Wenjing

Epilepsy Center,Tsinghua University Yuquan Hospital(Tsinghua University Integrated Traditional Chinese and Western Medicine Hospital),Beijing, 100040,China

Received:2025-05-12 Online:2025-06-25 Published:2025-12-25
Contact: Zhou Wenjing closejeo@hotmail.com

摘要/Abstract

摘要： 目的探讨无磁共振兼容手术室条件下开展磁共振引导下激光间质热疗(MRI guided laser interstitial thermal therapy,MRgLITT)治疗局灶性癫痫的安全性与有效性。方法回顾性分析2020年11月至2024年1月清华大学玉泉医院癫痫中心行MRgLITT的62例局灶性癫痫患者的临床资料,根据LITT前是否行电极置入及切除性手术,将患者分为四组:直接行MRgLITT组(组1),MRgLITT前只行电极置入组(组2),MRgLITT前只行致痫灶切除组(组3),MRgLITT前行电极置入及切除术组(组4)。随访截至2025年3月1日,分析手术疗效及并发症。结果共行MRgLITT手术74人次(53例1次,9例2次及以上),15人次采用神经阻滞+局部麻醉, 59人次采用静脉全身麻醉。末次治疗后随访13~48个月(中位32个月),末次随访时无发作率(ILAE 1 级)为54.8%,有效率(ILAE 1～3级)为66.1%。不同入组流程患者末次随访时无发作率差异显著(P＜0.001),经Bonferroni校正后,直接行LITT组(组1)无发作率显著高于LITT前只行致痫灶切除组(组3)和电极置入及切除术组(组4)(分别为P=0.002和P＜0.001);组1与组2差异未达到统计学意义(P=0.023>0.0083)。局灶性皮层发育不良组与结节性硬化组在末次随访时无发作率差异无统计学意义(56.7% vs 60.0%,χ²=0.062,P=0.803)。SEEG引导下射频热凝显效患者LITT后无发作率高于无显效患者(64.7% vs 18.8%,P=0.013)。术后并发症包括术区出血1例(经保守治疗无遗留症状)、一过性轻偏瘫5例,一过性低钠血症1例、一过性低氧血症2例,术中光纤断裂1例。无术后感染和死亡病例。结论无磁共振兼容手术室条件下可安全有效地开展磁共振引导下激光间质热疗治疗局灶性癫痫;致痫灶明确且局灶的患者疗效良好。

关键词: 无磁共振兼容手术室, 磁共振引导下激光间质热疗, 局灶性癫痫

Abstract: Objective To evaluate the safety and efficacy of magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) for focal epilepsy in a non-magnetic resonance (MR)-compatible operating room setting.Methods We retrospectively analyzed the clinical data of 62 patients with focal epilepsy who underwent MRgLITT in the Department of Neurosurgery at Tsinghua University Yuquan Hospital between November 2020 and January 2024.The cohort was stratified into four groups according to pre-LITT surgical history:Group 1 (direct MRgLITT),Group 2 (MRgLITT preceded only by intracranial electrode implantation),Group 3 (MRgLITT preceded only by resection of the epileptogenic zone),and Group 4 (MRgLITT preceded by both electrode implantation and resection).Follow-up continued until March 1,2025,with outcomes and complications analyzed.Results A total of 74 MRgLITT procedures were performed (53 patients underwent 1 session,9 underwent ≥2 sessions).Anesthesia included nerve block/local anesthesia (15 procedures) and intravenous anesthesia (59 procedures).At the last follow-up (median:32 months;range:13~48 months post-treatment),the seizure-free rate (ILAE Class 1) was 54.8%,and the responder rate (ILAE Classes 1-3) was 66.1%.Significant differences in seizure-free rates were observed among the four groups (P＜0.001).After Bonferroni correction,Group 1 showed significantly higher seizure-free rates than Group 3 (P=0.002) and Group 4 (P＜0.001),but no statistically significant difference versus Group 2 (P=0.023 > 0.0083).No significant difference in seizure-free rates was found between focal cortical dysplasia and tuberous sclerosis complex subgroups (56.7% vs.60.0%;χ²=0.062,P=0.803).Complications included intraoperative fiber breakage (1 cases),transient hemiparesis (5 cases),asymptomatic hemorrhage (1 case,managed conservatively),transient hyponatremia (1 case),and transient hypoxemia (2 cases).No postoperative infections or deaths occurred.Conclusion MRgLITT can be safely and effectively performed for focal epilepsy in a non-MR-compatible operating room setting,with favorable outcomes in patients with well-defined,localized epileptogenic foci.

Key words: Non-MR-compatible operating room, Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT), Focal epilepsy

中图分类号:

R742.1

柏建军, 范婷, 林久銮, 于翠萍, 张冰清, 王海祥, 丰倩, 宋宪成, 史洁, 刘一鸥, 孙朝晖, 贺晶, 阮静, 李佳, 周文静. 无MRI兼容手术室条件下开展MRI引导下激光间质热疗治疗局灶性癫痫的安全性和有效性[J]. 立体定向和功能性神经外科杂志, 2025, 38(3): 135-143.

Bai Jianjun, Fan Ting, Lin Jiuluan, Yu Cuiping, Zhang Bingqing, Wang Haixiang, Song Xiancheng, Shi Jie, Liu Yiou, Sun Zhaohui, He Jing, Ruan Jing, Li Jia, Zhou Wenjing. Safety and Efficacy of Magnetic Resonance-Guided Laser Interstitial Thermal Therapy for Focal Epilepsy in a Non-Magnetic Resonance-Compatible Operating Room Setting[J]. Chinese Journal of Stereotactic and Functional Neurosurgery, 2025, 38(3): 135-143.

参考文献

[1] Curry DJ,Gowda A,Mcnichols RJ,et al.MR-guided stereotactic laser ablation of epileptogenic foci in children[J].Epilepsy & Behavior, 2012,24(4):408~414.
[2] 柏建军,周文静,刘文博,等.磁共振引导下国产激光消融治疗系统消融活体脑组织的动物实验研究[J].立体定向和功能性神经外科杂志.2021,34(4):193~198.
[3] 胡文瀚,莫嘉杰,刘畅,等.磁共振引导激光间质热疗治疗药物难治性癫痫的手术策略及疗效[J].中华神经外科杂志.2021,37(8):764~770.
[4] 陈思畅,王逸鹤,樊晓彤,等.国产磁共振引导激光间质热疗治疗药物难治性癫痫的安全性及短期有效性观察[J].中华医学杂志.2021,101(41):3399~3403.
[5] 胡文瀚,姚远,莫嘉杰,等.磁共振引导下激光间质热疗治疗药物难治性癫痫的疗效分析[J].癫痫杂志,2022,8(3):202~206.
[6] Tomschik M,Herta J,Wais J,et al.Technical note:advantages of a 2-room intraoperative 3-tesla magnetic resonance imaging operating suite for performing laser interstitial thermal therapy in pediatric epilepsy and tumor surgery[J].World Neurosurgery,2023,179:146~152.
[7] Lin JQ,Gao W,Ying YQ,et al.Magnetic resonance-guided laser interstitial thermal therapy using dual-wavelength dual-output laser within two probe trajectories for treatment of drug-resistant epilepsy[J].CNS Neurosci Ther,2024,30(11):e70118.
[8] Jensdottir M,Sandvik U,Fagerlund M,et al.Laser interstitial thermal therapy using the Leksell Stereotactic System and a diagnostic MRI suite:how I do it[J].Acta Neurochir,2023,165(2):549~554.
[9] Bridges J,Folse M,Terrell D,et al.Robot-assisted laser interstitial thermal therapy for drug-resistant epilepsy in hypothalamic hamartoma[J].Neurosurg Focus Video,2024,11(1):V16.
[10] Paquin-Lanthier G,Subramaniam S,Leong K W,et al.Risk factors and characteristics of intraoperative seizures during awake craniotomy:a retrospective cohort study of 562 consecutive patients with a space-occupying brain lesion[J].J Neurosurg Anesthesiol,2023,35(2):194~200.
[11] Barot N,Batra K,Zhang J,et al.Surgical outcomes between temporal,extratemporal epilepsies and hypothalamic hamartoma:systematic review and meta-analysis of MRI-guided laser interstitial thermal therapy for drug-resistant epilepsy[J].J Neurol Neurosurg Psychiatry,2022,93(2):133~143.
[12] Chen JS,Lamoureux AA,Shlobin N A,et al.Magnetic resonance-guided laser interstitial thermal therapy for drug-resistant epilepsy:A systematic review and individual participant data meta-analysis[J].Epilepsia,2023,64(8):1957~1974.
[13] Ekman FR,Bjellvi J,Ljunggren S,et al.Laserinterstitial thermal therapy versus open surgery for mesial temporal lobe epilepsy:a systematic review and meta-analysis[J].World Neurosurg,2024,192:224~235.
[14] Mohsen Y,Sarhan K,Alawadi IS,et al.Efficacy and safety of laser interstitial thermal therapy versus radiofrequency ablation and stereotactic radiosurgery in the treatment of intractable mesial temporal lobe epilepsy:a systematic review and meta-analysis[J].Neurosurg Rev,2025,48(1):71.
[15] Hu WH,Mo JJ,Yang BW,et al.Voxel-based morphometric MRI postprocessing-assisted laser interstitial thermal therapy for focal cortical dysplasia-suspected lesions:technique and outcomes[J].Oper Neurosurg,2022,23(4):334~341.
[16] Chen SC,Wang YH,Fan XT,et al.[Safety and short-term efficacy of domestic magnetic resonance-guided laser interstitial thermotherapy in the treatment of drug-resistant epilepsy][J].Zhonghua Yi Xue Za Zhi,2021,101(41):3399~3403.
[17] Yang BW,Zhang C,Wang X,et al.Laser interstitial thermal therapy in the management of bottom‐of‐sulcus dysplasia‐related epilepsy[J].Ann ClinTransl Neurol,2025,12(1):110~120.
[18] Ellis JA,Mejia Munne JC,Wang S H,et al.Staged laser interstitial thermal therapy and topectomy for complete obliteration of complex focal cortical dysplasias[J].J Clin Neurosci,2016,31:224~228.
[19] Devine IM,Burrell CJ,Shih JJ.Curative laser thermoablation of epilepsy secondary to bottom-of-sulcus dysplasia near eloquent cortex[J].Seizure,2016,34:35~37.
[20] Lewis EC,Weil AG,Duchowny M,et al.MR-guided laser interstitial thermal therapy for pediatric drug-resistant lesional epilepsy[J].Epilepsia,2015,56(10):1590~1598.
[21] Gupta K,Cabaniss B,Kheder A,et al.Stereotactic MRI-guided laser interstitial thermal therapy for extratemporal lobe epilepsy[J].Epilepsia,2020,61(8):1723~1734.
[22] Infante N,Conesa G,Pérez-Enríquez C,et al.MRI-guided laser interstitial thermal therapy in epilepsy:indications,technique and outcome in an adult population.A single-center data analysis[J].Acta Neurochirurgica,2025,167(1).
[23] Tovar-Spinoza Z,Ziechmann R,Zyck S.Single and staged laser interstitial thermal therapy ablation for cortical tubers causing refractory epilepsy in pediatric patients[J].Neurosurg Focus,2018,45(3):E9.
[24] Onorini N,Mirone G,Cicala D,et al.Simultaneous robotic-assisted laser thermal ablation of multiple cortical tubers for drug-resistant epilepsy in a 17-year-old patient with tuberous sclerosis complex[J].World Neurosurg,2024,192:127~129.
[25] Stellon MA,Cobourn K,Whitehead MT,et al.“Laser and the Tuber”:thermal dynamic and volumetric factors influencing seizure outcomes in pediatric subjects with tuberous sclerosis undergoing stereoencephalography-directed laser ablation of tubers[J].Childs Nerv Syst,2019,35(8):1333~1340.
[26] Barros GM,Johnstone T,Li D,et al.Approach,complications,and outcomes for 37 consecutive pediatric patients undergoing laser ablation for medically refractory epilepsy at Stanford Children's Health[J].J Neurosurg Pediatr,2024,33(1):1~11.

无MRI兼容手术室条件下开展MRI引导下激光间质热疗治疗局灶性癫痫的安全性和有效性

Safety and Efficacy of Magnetic Resonance-Guided Laser Interstitial Thermal Therapy for Focal Epilepsy in a Non-Magnetic Resonance-Compatible Operating Room Setting

PDF

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 2

编辑推荐

Metrics

本文评价

[1]	郭效东, 路小奇, 刘明辉, 王振华, 许鹏, 杨新超, 郝文明, 娄云霄, 李经纶, 李俊龙, 田海港. 立体脑电图引导下射频热凝毁损术在药物难治性局灶性癫痫患者中的应用价值[J]. 立体定向和功能性神经外科杂志, 2025, 38(2): 77-83.
[2]	蒋丹, 杨小芳, 康瑜. 局灶性癫痫发作的脑电时空特征及其与患者耐药的相关性分析[J]. 立体定向和功能性神经外科杂志, 2024, 37(5): 267-273.