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Pediatric Neurosurgery: Tricks of the Trade || 104 Laser Ablation of Deep Lesions

DOI:10.1055/b-0035-125989 出版年份:2016 更新时间:2025-09-12 10:27:22
摘要: A major goal of neurosurgical management of many deep lesions is to safely destroy, or neutralize the consequences of, a lesion without damage to nearby structures. “Neutralization” here means to render harmless, as in cases where deep lesions cause seizures, such as hypothalamic hamartomas or lesions of the hippocampus. A stereotactic procedure that minimally disrupts other tissue and avoids the long-term effects of ionizing radiation (as with stereotactic radiosurgery [SRS]) may prove to be the strategy of choice. For the technique described in this chapter, laser interstitial thermoablative therapy (LITT), the key additional safety element is the ability to observe the anatomical boundaries and progress of the laser lesion as it is being made. Since the procedure is performed “closed” through a twist-drill hole, the visualization of the lesion is effected using real-time magnetic resonance imaging (MRI) observation of the target—and automated control of the laser to turn the power off when specific criteria are met. Many of the nuances of the procedure therefore depend on an understanding of the underlying phenomena and on the ability to interact with the stereotactic and laser control software.
作者: Joseph R. Madsen
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To safely destroy or neutralize deep lesions without damaging nearby structures using laser interstitial thermoablative therapy (LITT) with real-time MRI observation.

LITT offers a minimally invasive approach to treat deep lesions with significantly less morbidity than open craniotomy and a very short hospital stay. The ability to observe the anatomical boundaries and progress of the laser lesion in real-time MRI enhances the safety and precision of the procedure. However, the technique's applicability is limited by the target's geometry and the risk of postoperative edema. Future developments in software and hardware could further optimize the procedure.

The procedure requires the target to be evident in an MRI field and is most appropriate for targets with a relatively small diameter (up to 3 cm) and a spherical or cylindrical overall shape. There is a risk of postoperative edema, especially for large lesions or those in the brainstem. The procedure's success heavily depends on the precision of the laser placement and the integrity of the drilled hole.

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