立体定向激光消融术治疗脑海绵状血管瘤所致癫痫的安全性和有效性_Journal of Epilepsy

Authors：

 Jon TWillie ,  James GMalcolm , Matthew AStern , 张乐　译 , 慕洁　审

Corresponding author：

Jon TWillie, Email: jon.t.willie; James GMalcolm, Email: rgross@emory.edu

Keywords：

脑海绵状血管瘤; 激光间隙热疗; 病灶性癫痫; 磁共振测温; 癫痫发作; 立体定向激光消融术

DOI：

10.7507/2096-0247.20200059

Video：

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核磁共振（MR）热成像引导激光间隙热疗或立体定向激光消融术（Stereotactic laser ablation，SLA）是开颅手术治疗脑海绵状血管瘤（Cerebral cavernous malformations，CCMs）所致局灶性癫痫的微创替代术。此研究检测了 SLA 治疗致痫性 CCMs 的安全性和有效性，回顾性分析连续 19 例伴有 CCM 的局部发作的患者。每例患者均接受 CCMs 和邻近皮质的 SLA，继而进行标准的临床和影像学随访。除 1 例患者外，所有患者均患有慢性难治性癫痫（中位病程 8 年，年龄范围 0.5～52 岁）。病变位于颞叶（13 例）、额叶（5 例）和顶叶（1 例）。CCMs 在测温过程中会诱发磁化率伪影，但病灶周围皮层易于观察。在接受 12 个月以上随访的 17 例患者中，有 14 例（82%）达到了 Engel I 级，其中 10 例（59%）为 Engel IA 级。2 例患者仅接受 SLA 后未达到无发作，在进一步行颅内电极引导下开放性切除术后达到了无发作。延迟的术后影像学检查证实了 CCMs 缩小（中位数减少 83%）和周围皮质的消融。开放手术后对一个先前消融的 CCM 组织病理学检查证实闭塞。SLA 未引起可检测的出血。两种症状性神经功能缺损（视觉和运动障碍）是可预见的，且均非永久残疾。在连续的回顾性研究中，MR 热成像指导的 SLA 是致痫性 CCMs 开放手术治疗的有效替代方法。该方法无出血并发症，且临床上明显的神经功能缺损是可预见的。若有需要，SLA 对后续的开放手术无任何障碍。

Citation： Jon TWillie, James GMalcolm, Matthew AStern, 张乐　译, 慕洁　审. 立体定向激光消融术治疗脑海绵状血管瘤所致癫痫的安全性和有效性. Journal of Epilepsy, 2020, 6(4): 366-376. doi: 10.7507/2096-0247.20200059 Copy

1.	Raychaudhuri R, Batjer HH, Awad IA. Intracranial cavernous angioma: a practical review of clinical and biological aspects. Surg Neurol, 2005, 63(2): 319-328.
2.	Rosenow F, Alonso-Vanegas MA, Baumgartner C, et al. Cavernoma‐related epilepsy: review and recommendations for management ‐ Report of the Surgical Task Force of the ILAE Commission on Therapeutic Strategies. Epilepsia, 2013, 54(Suppl 2): 2025-2035.
3.	Poorthuis MHF, Klijn CJM, Algra A, et al. Treatment of cerebral cavernous malformations: a systematic review and meta‐regression analysis. J Neurol Neurosurg Psychiatry, 2014, 85(10): 1319-1323.
4.	Baumann CR, Schuknecht B, Lo Russo G, et al. Seizure outcome after resection of cavernous malformations is better when surrounding hemosiderin‐stained brain also is removed. Epilepsia, 2006, 47(3): 563-566.
5.	von der Brelie C, von Lehe M, Raabe A, et al. Surgical resection can be successful in a large fraction of patients with drug‐resistant epilepsy associated with multiple cerebral cavernous malformations. Neurosurgery, 2014, 74(1): 147-153.
6.	Kim W, Stramotas S, Choy W, et al. Prognostic factors for post‐operative seizure outcomes after cavernous malformation treatment. J Clin Neurosci, 2011, 18(5): 877-880.
7.	Horne MA, Flemming KD, Su IC, et al. Clinical course of untreated cerebral cavernous malformations: a meta‐analysis of individual patient data. Lancet Neurol, 2016, 15(2): 166-173.
8.	Steiger HJ, Markwalder TM, Reulen HJ. Clinicopathological relations of cerebral cavernous angiomas - observations in 11 cases. Neurosurgery, 1987, 21(5): 879-884.
9.	Awad I, Jabbour P. Cerebral cavernous malformations and epilepsy. Neurosurg Focus, 2006, 21(1): e7.
10.	Chang EF, Gabriel RA, Potts MB, et al. Supratentorial cavernous malformations in eloquent and deep locations: surgical approaches and outcomes Clinical article. J Neurosurg, 2011, 114(6): 814-827.
11.	Moran NF, Fish DR, Kitchen N, et al. Supratentorial cavernous haemangiomas and epilepsy: a review of the literature and case series. J Neurol Neurosurg Psychiatry, 1999, 66(4): 561-568.
12.	McNichols RJ, Gowda A, Kangasniemi M, et al. MR thermometry‐based feedback control of laser interstitial thermal therapy at 980 nm. Lasers Surg Med, 2004, 34(1): 48-55.
13.	Willie JT, Laxpati NG, Drane DL, et al. Real‐time magnetic resonance‐guided stereotactic laser amygdalohippocampotomy for mesial temporal lobe epilepsy. Neurosurgery, 2014, 74(4): 569-584.
14.	Curry DJ, Gowda A, McNichols RJ, et al. MR‐guided stereotactic laser ablation of epileptogenic foci in children. Epilepsy Behav, 2012, 24(3): 408-414.
15.	Schwarzmaier HJ, Eickmeyer F, von Tempelhoff W, et al. MR‐guided laser‐induced interstitial thermotherapy of recurrent glioblastoma multiforme: preliminary results in 16 patients. Eur J Radiol, 2006, 59(2): 208-215.
16.	Carpentier A, Chauvet D, Reina V, et al. MR‐guided laser‐induced thermal therapy (LITT) for recurrent glioblastomas. Lasers Surg Med, 2012, 44(2): 361-368.
17.	Tovar-Spinoza Z, Carter D, Ferrone D, et al. The use of MRI‐guided laser‐induced thermal ablation for epilepsy. Childs Nerv Syst, 2013, 29(Suppl): 2089-2094.
18.	Rao MS, Hargreaves EL, Khan AJ, et al. Magnetic resonance‐guided laser ablation improves local control for postradiosurgery recurrence and/or radiation necrosis. Neurosurgery, 2014, 74(4): 658-667.
19.	Hawasli AH, Bagade S, Shimony JS, et al. Magnetic resonance imaging‐guided focused laser interstitial thermal therapy for intracranial lesions: single‐institution series. Neurosurgery, 2013, 73(8): 1007-1017.
20.	Drane D, Loring D, Voets N, et al. Temporal lobe epilepsy surgical patients undergoing MRI‐guided stereotactic laser ablation exhibit better episodic memory outcome as compared to standard surgical approaches. Epilepsy Curr, 2014, 14(3): 468-469.
21.	Gross RE, Stern MA, Willie JT, et al. Stereotactic laser amygdalohippocampotomy for mesial temporal lobe epilepsy. Ann Neurol, 2018, 83(3): 575-587.
22.	Drane DL, Loring DW, Voets NL, et al. Better object recognition and naming outcome with MRI‐guided stereotactic laser amygdalohippocampotomy for temporal lobe epilepsy. Epilepsia, 2015, 56(1): 101-113.
23.	McCracken DJ, Willie JT, Fernald BA, et al. Magnetic resonance thermometry‐guided stereotactic laser ablation of cavernous malformations in drug‐resistant epilepsy: imaging and clinical results. Oper Neurosurg (Hagerstown), 2016, 12(1): 39-48.
24.	Fisher RS, Cross JH, French JA, et al. Operational classification of seizure types by the International League Against Epilepsy: position Paper of the ILAE Commission for Classification and Terminology. Epilepsia, 2017, 58(4): 522-530.
25.	Willie JT, Tung JK, Gross RE. Chapter 16 - MRI-Guided Stereotactic Laser Ablation A2. In: Golby AJ, editor. Imageguided neurosurgery. Boston, MA: Academic Press, 2015: 375-403.
26.	Engel J, Van Ness PC, Rasmussen TB, et al. Outcome with Respect to Epileptic Seizures. In: Surgical Treatment of the Epilepsies, 2nd edn. Engel J (ed). New York: Raven Press, 1993: 609-621.
27.	Hauser WA, Kurland LT. The epidemiology of epilepsy in rochester, Minnesota, 1935 through 1967. Epilepsia, 1975, 16(1): 1-66.
28.	Lewis EC, Weil AG, Duchowny M, et al. MR‐guided laser interstitial thermal therapy for pediatric drug‐resistant lesional epilepsy. Epilepsia, 2015, 56(Suppl 1): 1590-1598.
29.	Jethwa PR, Barrese JC, Gowda A, et al. Magnetic resonance thermometry‐guided laser‐induced thermal therapy for intracranial neoplasms: initial experience. Neurosurgery, 2012, 71(1): 133-144.
30.	Hawasli AH, Ray WZ, Murphy RKJ, et al. Magnetic resonance imaging‐guided focused laser interstitial thermal therapy for subinsular metastatic adenocarcinoma: technical case report. Neurosurgery, 2012, 70(2): 332-338.
31.	Jethwa PR, Lee JH, Assina R, et al. Treatment of a supratentorial primitive neuroectodermal tumor using magnetic resonance‐ guided laser‐induced thermal therapy. J Neurosurg Pediatr, 2011, 8(3): 468-475.
32.	Sloan AE, Ahluwalia MS, Valerio-Pascua J, et al. Results of the Neuro blate system first‐in‐humans phase i clinical trial for recurrent glioblastoma clinical article. J Neurosurg, 2013, 118(10): 1202-1219.
33.	Leonardi MA, Lumenta CB. Stereotactic guided laser‐induced interstitial thermotherapy (SLITT) in gliomas with intraoperative morphologic monitoring in an open MR: clinical experience. Minim Invasive Neurosurg, 2002, 45(2): 201-207.
34.	Esquenazi Y, Kalamangalam GP, Slater JD, et al. Stereotactic laser ablation of epileptogenic periventricular nodular heterotopia. Epilepsy Res, 2014, 108(4): 547-554.
35.	Akers A, Al-Shahi SR, AAwad I, et al. Synopsis of guidelines for the clinical management of cerebral cavernous malformations: Consensus recommendations based on systematic literature review by the angioma alliance scientific advisory board clinical experts panel. Neurosurgery, 2017, 80(5): 665-680.
36.	Jehi LE, Palmini A, Aryal U, et al. Cerebral cavernous malformations in the setting of focal epilepsies: pathological findings, clinical characteristics, and surgical treatment principles. Acta Neuropathol, 2014, 128(1): 55-65.
37.	Yeon JY, Kim JS, Choi SJ, et al. Supratentorial cavernous angiomas presenting with seizures: surgical outcomes in 60 consecutive patients. Seizure, 2009, 18(1): 14-20.
38.	Hsu PW, Chang CN, Tseng CK, et al. Treatment of epileptogenic cavernomas: surgery versus radiosurgery. Cerebrovasc Dis, 2007, 24(1): 116-120, discussion 121.
39.	Bartolomei F, Regis J, Kida Y, et al. Gamma Knife radiosurgery for epilepsy associated with cavernous hemangiomas: a retrospective study of 49 cases. Stereotact Funct Neurosurg, 1999, 72(1): 22-28.
40.	Cappabianca P, Alfieri A, Maiuri F, et al. Supratentorial cavernous malformations and epilepsy: seizure outcome after lesionectomy on a series of 35 patients. Clin Neurol Neurosurg, 1997, 99(2): 179-183.
41.	Zanello M, Wager M, Corns R, et al. Resection of cavernous angioma located in eloquent areas using functional cortical and subcortical mapping under awake conditions. Outcomes in a 50‐case multicentre series. Neurochirurgie, 2017, 63(2): 219-226.
42.	Delev D, Oehl B, Steinhoff BJ, et al. Surgical treatment of extratemporal epilepsy: results and prognostic factors. Neurosurgery, 2018, 13(2): e0196274.
43.	Kondziolka D, Flickinger JC, Lunsford LD. Stereotactic radiosurgery for epilepsy and functional disorders. Neurosurg Clin N Am, 2013, 24(5): 623-632.
44.	Barbaro NM, Quigg M, Ward MM, et al. Radiosurgery versus open surgery for mesial temporal lobe epilepsy: The randomized, controlled ROSE trial. Epilepsia, 2018, 59(10): 1198-1207.
45.	Quigg M, Harden C. Minimally invasive techniques for epilepsy surgery: stereotactic radiosurgery and other technologies. J Neurosurg, 2014, 121(Suppl 2): 232-240.
46.	Consiglieri GD, Killory BD, Germain RS, et al. Utility of the CO² laser in the microsurgical resection of cavernous malformations. World Neurosurg, 2013, 79(6): 714-718.

1. Raychaudhuri R, Batjer HH, Awad IA. Intracranial cavernous angioma: a practical review of clinical and biological aspects. Surg Neurol, 2005, 63(2): 319-328.
2. Rosenow F, Alonso-Vanegas MA, Baumgartner C, et al. Cavernoma‐related epilepsy: review and recommendations for management ‐ Report of the Surgical Task Force of the ILAE Commission on Therapeutic Strategies. Epilepsia, 2013, 54(Suppl 2): 2025-2035.
3. Poorthuis MHF, Klijn CJM, Algra A, et al. Treatment of cerebral cavernous malformations: a systematic review and meta‐regression analysis. J Neurol Neurosurg Psychiatry, 2014, 85(10): 1319-1323.
4. Baumann CR, Schuknecht B, Lo Russo G, et al. Seizure outcome after resection of cavernous malformations is better when surrounding hemosiderin‐stained brain also is removed. Epilepsia, 2006, 47(3): 563-566.
5. von der Brelie C, von Lehe M, Raabe A, et al. Surgical resection can be successful in a large fraction of patients with drug‐resistant epilepsy associated with multiple cerebral cavernous malformations. Neurosurgery, 2014, 74(1): 147-153.
6. Kim W, Stramotas S, Choy W, et al. Prognostic factors for post‐operative seizure outcomes after cavernous malformation treatment. J Clin Neurosci, 2011, 18(5): 877-880.
7. Horne MA, Flemming KD, Su IC, et al. Clinical course of untreated cerebral cavernous malformations: a meta‐analysis of individual patient data. Lancet Neurol, 2016, 15(2): 166-173.
8. Steiger HJ, Markwalder TM, Reulen HJ. Clinicopathological relations of cerebral cavernous angiomas - observations in 11 cases. Neurosurgery, 1987, 21(5): 879-884.
9. Awad I, Jabbour P. Cerebral cavernous malformations and epilepsy. Neurosurg Focus, 2006, 21(1): e7.
10. Chang EF, Gabriel RA, Potts MB, et al. Supratentorial cavernous malformations in eloquent and deep locations: surgical approaches and outcomes Clinical article. J Neurosurg, 2011, 114(6): 814-827.
11. Moran NF, Fish DR, Kitchen N, et al. Supratentorial cavernous haemangiomas and epilepsy: a review of the literature and case series. J Neurol Neurosurg Psychiatry, 1999, 66(4): 561-568.
12. McNichols RJ, Gowda A, Kangasniemi M, et al. MR thermometry‐based feedback control of laser interstitial thermal therapy at 980 nm. Lasers Surg Med, 2004, 34(1): 48-55.
13. Willie JT, Laxpati NG, Drane DL, et al. Real‐time magnetic resonance‐guided stereotactic laser amygdalohippocampotomy for mesial temporal lobe epilepsy. Neurosurgery, 2014, 74(4): 569-584.
14. Curry DJ, Gowda A, McNichols RJ, et al. MR‐guided stereotactic laser ablation of epileptogenic foci in children. Epilepsy Behav, 2012, 24(3): 408-414.
15. Schwarzmaier HJ, Eickmeyer F, von Tempelhoff W, et al. MR‐guided laser‐induced interstitial thermotherapy of recurrent glioblastoma multiforme: preliminary results in 16 patients. Eur J Radiol, 2006, 59(2): 208-215.
16. Carpentier A, Chauvet D, Reina V, et al. MR‐guided laser‐induced thermal therapy (LITT) for recurrent glioblastomas. Lasers Surg Med, 2012, 44(2): 361-368.
17. Tovar-Spinoza Z, Carter D, Ferrone D, et al. The use of MRI‐guided laser‐induced thermal ablation for epilepsy. Childs Nerv Syst, 2013, 29(Suppl): 2089-2094.
18. Rao MS, Hargreaves EL, Khan AJ, et al. Magnetic resonance‐guided laser ablation improves local control for postradiosurgery recurrence and/or radiation necrosis. Neurosurgery, 2014, 74(4): 658-667.
19. Hawasli AH, Bagade S, Shimony JS, et al. Magnetic resonance imaging‐guided focused laser interstitial thermal therapy for intracranial lesions: single‐institution series. Neurosurgery, 2013, 73(8): 1007-1017.
20. Drane D, Loring D, Voets N, et al. Temporal lobe epilepsy surgical patients undergoing MRI‐guided stereotactic laser ablation exhibit better episodic memory outcome as compared to standard surgical approaches. Epilepsy Curr, 2014, 14(3): 468-469.
21. Gross RE, Stern MA, Willie JT, et al. Stereotactic laser amygdalohippocampotomy for mesial temporal lobe epilepsy. Ann Neurol, 2018, 83(3): 575-587.
22. Drane DL, Loring DW, Voets NL, et al. Better object recognition and naming outcome with MRI‐guided stereotactic laser amygdalohippocampotomy for temporal lobe epilepsy. Epilepsia, 2015, 56(1): 101-113.
23. McCracken DJ, Willie JT, Fernald BA, et al. Magnetic resonance thermometry‐guided stereotactic laser ablation of cavernous malformations in drug‐resistant epilepsy: imaging and clinical results. Oper Neurosurg (Hagerstown), 2016, 12(1): 39-48.
24. Fisher RS, Cross JH, French JA, et al. Operational classification of seizure types by the International League Against Epilepsy: position Paper of the ILAE Commission for Classification and Terminology. Epilepsia, 2017, 58(4): 522-530.
25. Willie JT, Tung JK, Gross RE. Chapter 16 - MRI-Guided Stereotactic Laser Ablation A2. In: Golby AJ, editor. Imageguided neurosurgery. Boston, MA: Academic Press, 2015: 375-403.
26. Engel J, Van Ness PC, Rasmussen TB, et al. Outcome with Respect to Epileptic Seizures. In: Surgical Treatment of the Epilepsies, 2nd edn. Engel J (ed). New York: Raven Press, 1993: 609-621.
27. Hauser WA, Kurland LT. The epidemiology of epilepsy in rochester, Minnesota, 1935 through 1967. Epilepsia, 1975, 16(1): 1-66.
28. Lewis EC, Weil AG, Duchowny M, et al. MR‐guided laser interstitial thermal therapy for pediatric drug‐resistant lesional epilepsy. Epilepsia, 2015, 56(Suppl 1): 1590-1598.
29. Jethwa PR, Barrese JC, Gowda A, et al. Magnetic resonance thermometry‐guided laser‐induced thermal therapy for intracranial neoplasms: initial experience. Neurosurgery, 2012, 71(1): 133-144.
30. Hawasli AH, Ray WZ, Murphy RKJ, et al. Magnetic resonance imaging‐guided focused laser interstitial thermal therapy for subinsular metastatic adenocarcinoma: technical case report. Neurosurgery, 2012, 70(2): 332-338.
31. Jethwa PR, Lee JH, Assina R, et al. Treatment of a supratentorial primitive neuroectodermal tumor using magnetic resonance‐ guided laser‐induced thermal therapy. J Neurosurg Pediatr, 2011, 8(3): 468-475.
32. Sloan AE, Ahluwalia MS, Valerio-Pascua J, et al. Results of the Neuro blate system first‐in‐humans phase i clinical trial for recurrent glioblastoma clinical article. J Neurosurg, 2013, 118(10): 1202-1219.
33. Leonardi MA, Lumenta CB. Stereotactic guided laser‐induced interstitial thermotherapy (SLITT) in gliomas with intraoperative morphologic monitoring in an open MR: clinical experience. Minim Invasive Neurosurg, 2002, 45(2): 201-207.
34. Esquenazi Y, Kalamangalam GP, Slater JD, et al. Stereotactic laser ablation of epileptogenic periventricular nodular heterotopia. Epilepsy Res, 2014, 108(4): 547-554.
35. Akers A, Al-Shahi SR, AAwad I, et al. Synopsis of guidelines for the clinical management of cerebral cavernous malformations: Consensus recommendations based on systematic literature review by the angioma alliance scientific advisory board clinical experts panel. Neurosurgery, 2017, 80(5): 665-680.
36. Jehi LE, Palmini A, Aryal U, et al. Cerebral cavernous malformations in the setting of focal epilepsies: pathological findings, clinical characteristics, and surgical treatment principles. Acta Neuropathol, 2014, 128(1): 55-65.
37. Yeon JY, Kim JS, Choi SJ, et al. Supratentorial cavernous angiomas presenting with seizures: surgical outcomes in 60 consecutive patients. Seizure, 2009, 18(1): 14-20.
38. Hsu PW, Chang CN, Tseng CK, et al. Treatment of epileptogenic cavernomas: surgery versus radiosurgery. Cerebrovasc Dis, 2007, 24(1): 116-120, discussion 121.
39. Bartolomei F, Regis J, Kida Y, et al. Gamma Knife radiosurgery for epilepsy associated with cavernous hemangiomas: a retrospective study of 49 cases. Stereotact Funct Neurosurg, 1999, 72(1): 22-28.
40. Cappabianca P, Alfieri A, Maiuri F, et al. Supratentorial cavernous malformations and epilepsy: seizure outcome after lesionectomy on a series of 35 patients. Clin Neurol Neurosurg, 1997, 99(2): 179-183.
41. Zanello M, Wager M, Corns R, et al. Resection of cavernous angioma located in eloquent areas using functional cortical and subcortical mapping under awake conditions. Outcomes in a 50‐case multicentre series. Neurochirurgie, 2017, 63(2): 219-226.
42. Delev D, Oehl B, Steinhoff BJ, et al. Surgical treatment of extratemporal epilepsy: results and prognostic factors. Neurosurgery, 2018, 13(2): e0196274.
43. Kondziolka D, Flickinger JC, Lunsford LD. Stereotactic radiosurgery for epilepsy and functional disorders. Neurosurg Clin N Am, 2013, 24(5): 623-632.
44. Barbaro NM, Quigg M, Ward MM, et al. Radiosurgery versus open surgery for mesial temporal lobe epilepsy: The randomized, controlled ROSE trial. Epilepsia, 2018, 59(10): 1198-1207.
45. Quigg M, Harden C. Minimally invasive techniques for epilepsy surgery: stereotactic radiosurgery and other technologies. J Neurosurg, 2014, 121(Suppl 2): 232-240.
46. Consiglieri GD, Killory BD, Germain RS, et al. Utility of the CO² laser in the microsurgical resection of cavernous malformations. World Neurosurg, 2013, 79(6): 714-718.

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立体定向激光消融术治疗脑海绵状血管瘤所致癫痫的安全性和有效性

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