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

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.