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Highly realistic simulation for robot-assisted hypothalamic hamartoma real-time MRI-guided laser interstitial thermal therapy (LITT)
摘要： Purpose Real-time MRI-guided laser interstitial thermal therapy (LITT) is a challenging procedure due to its technical complexity, as well as the need for efficient multidisciplinary teamwork and transfer of an anesthetized patient between operating room (OR) and magnetic resonance (MR). A highly realistic simulation was developed to design the safest process before being applied to real patients. In this report, authors address the description of the methodology used for this simulation and its purposefulness. Methods The entire image planning, anesthetic, and surgical process were performed on a modified pediatric simulation mannequin with a brain made of medical grade silicone including a hypothalamic hamartoma. Preoperative CT and MR were acquired. Stereotactic insertion of the optical fiber was assisted by the Neuromate? stereotactic robot. Laser ablation was performed with the Medtronic Visualase? MRI-guided system in a 3T Phillips Ingenia? MR scanner. All the stages of the process, participants, and equipment were the same as planned for a real surgery. Results No critical errors were found in the process design that prevented the procedure from being performed with adequate safety. Specific proposals for team positioning and interaction in patient transfers and in MR room were validated. Some specific elements that could improve safety were identified. Conclusion Highly realistic simulation has been an extremely useful tool for safely planning LITT, because professionals were able to take actions in the workflow based not on ideas but on lived experiences. It contributed definitively to build a well-coordinated surgical team that worked safely and more efficiently.
关键词： Robotic surgery,Patient safety,Pediatric epilepsy surgery,Risk management,Laser ablation
更新于2025-09-23 15:19:57
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Laser interstitial thermal therapy in drug-resistant epilepsy
摘要： MRI-guided stereotactic laser interstitial thermal therapy (LiTT) has been utilized in the surgical treatment of discrete, small epileptogenic lesions. This review summarizes the current literature and addresses the clinical application of this technique. LiTT has the potential to reduce the morbidity and discomfort of epilepsy surgery. Review of data from retrospective, uncontrolled studies suggests that LiTT may offer benefit when treating drug-resistant epilepsy because of mesial temporal sclerosis, hypothalamic hamartoma, cavernous hemangioma, and small cortical dysplasias and malformations. It is now being offered as initial therapy in place of anterior temporal lobectomy in many centers, and a prospective study is underway to compare it with historical temporal lobectomy reports. LiTT appears promising and has potential for reduced morbidity and improved tolerability compared with open surgery. Studies must be done to compare efficacy and safety of LiTT with open surgery, and further investigation is needed to optimize this technique.
关键词： magnetic resonance-guided laser interstitial thermal therapy,epilepsy surgery,laser ablation,temporal lobe epilepsy,drug-resistant epilepsy
更新于2025-09-11 14:15:04
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Early economic evaluation of MRI-guided laser interstitial thermal therapy (MRgLITT) and epilepsy surgery for mesial temporal lobe epilepsy
摘要： Background MRI-guided laser interstitial thermal therapy (MRgLITT) is a new minimally invasive treatment for temporal lobe epilepsy (TLE), with limited effectiveness data. It is unknown if the cost savings associated with shorter hospitalization could offset the high equipment cost of MRgLITT. We examined the cost-utility of MRgLITT versus surgery for TLE from healthcare payer perspective, and the value of additional research to inform policy decision on MRgLITT. Methods We developed a microsimulation model to evaluate quality adjusted life years (QALYs), costs, and incremental cost-effectiveness ratio (ICER) of MRgLITT versus surgery in TLE, assuming life-time horizon and 1.5% discount rate. Model inputs were derived from the literature. We conducted threshold and sensitivity analyses to examine parameter uncertainties, and expected value of partial perfect information analyses to evaluate the expected monetary benefit of eliminating uncertainty on probabilities associated with MRgLITT. Results MRgLITT yielded 0.08 more QALYs and cost $7,821 higher than surgery, with ICER of $94,350/QALY. Influential parameters that could change model outcomes include probabilities of becoming seizure-free from disabling seizures state and returning to disabling seizures from seizure-free state 5 years after surgery and MRgLITT, cost of MRgLITT disposable equipment, and utilities of disabling seizures and seizure-free states of surgery and MRgLITT. The cost-effectiveness acceptability curve showed surgery was preferred in more than 50% of iterations. The expected monetary benefit of eliminating uncertainty for probabilities associated with MRgLITT was higher than for utilities associated with MRgLITT. Conclusions MRgLITT resulted in more QALYs gained and higher costs compared to surgery in the base-case. The model was sensitive to variations in the cost of MRgLITT disposable equipment. There is value in conducting more research to reduce uncertainty on the probabilities and utilities of MRgLITT, but priority should be given to research focusing on improving the precision of estimates on effectiveness of MRgLITT.
关键词： MRI-guided laser interstitial thermal therapy,epilepsy surgery,economic evaluation,TLE,temporal lobe epilepsy,cost-utility,MRgLITT
更新于2025-09-11 14:15:04
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[ACM Press the 2nd International Conference - Las Vegas, NV, USA (2018.08.27-2018.08.29)] Proceedings of the 2nd International Conference on Vision, Image and Signal Processing - ICVISP 2018 - Localization of Epileptogenic Zone
摘要： For a class of focal epileptic patients having drug-resistant epilepsy, resective surgery seems to be a valid option for treatment. In case of surgery, a minimum amount of cerebral cortex known as Epileptogenic Zone (EZ) will be removed to achieve seizure freedom. Presurgical assessment is an important task since the outcome of surgery depends on how precisely EZ is localized. Analysis of electrical activities of the brain will help in localizing EZ. Stereo-Electroencephalogram (SEEG) is an invasive methodology to explore the bioelectrical activities of deep brain structures. Graph theory can be used for the analysis of SEEG, where each channel of SEEG is taken as a node and cross power transmission in beta and gamma frequency subbands are taken as an edge connecting them. Laplacian centrality measure is used to find the relative importance of a node in this graph and it represents the drop in Laplacian energy when that particular node is removed from the graph. In focal channels (channels in the EZ), at the seizure onset, there is a sharp increase in Laplacian centrality, which shows the extent of the contribution of these channel regions in seizure genesis. Finally, we have marked this extent of increase in centrality value to rank all the channels in the order of their epileptogenicity.
关键词： Graph Theory,Epileptogenic Zone,Laplacian Centrality,Epilepsy,Epilepsy Surgery,Centrality
更新于2025-09-10 09:29:36
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Multimodal medical imaging repository and information system in epilepsy surgery
摘要： Surgery is an option for patients with drug-resistant epilepsy, but it requires a comprehensive assessment. Electroencephalography (EEG), magnetic resonance imaging (MRI), and functional MRI (fMRI) are used to localize the epileptogenic zone, which directly affects the surgery outcome. Accessing EEG, MRI, and fMRI results and patient information simultaneously using traditional methods might result in misinformation and increase the workload of clinicians. In this study, we developed a modern web-based repository system for the preoperative evaluation of epilepsy disorder, including multimodal medical images and patient information. Our dedicated system is enriched with clinical metadata that are not currently available and is managed with an online application. It overcomes the identified problem and minimizes possible medical errors. In conclusion, this system has the potential to accelerate surgical procedures, get reliable results, and improve the seizure outcome. It is an extensive solution for epilepsy hospitals and clinical research centers. It may serve as a standard template for archiving multiple imaging techniques.
关键词： epilepsy surgery,Health information management,information system,multimodal medical imaging,electronic health records
更新于2025-09-10 09:29:36