Stereotaktische Laserthermokoagulation in der Epilepsiechirurgie

Abstract

In common with other stereotactic procedures, stereotactic laser thermocoagulation (SLT) promises gentle destruction of pathological tissue, which might become especially relevant for epilepsy surgery in the future. Compared to standard resection, no large craniotomy is necessary, cortical damage during access to deep-seated lesions can be avoided and interventions close to eloquent brain areas become possible. We describe the history and rationale of laser neurosurgery as well as the two available SLT systems (Visualase® and NeuroBlate®; CE marks pending). Both systems are coupled with magnetic resonance imaging (MRI) and MR thermometry, thereby increasing patient safety. We report the published clinical experiences with SLT in epilepsy surgery (altogether approximately 200 cases) with respect to complications, brain structural alterations, seizure outcome, neuropsychological findings and treatment costs. The rate of seizure-free patients seems to be slightly lower than for resection surgery. Due to the inadequate quality of studies, the neuropsychological superiority of SLT has not yet been unambiguously demonstrated.

A quantitative evaluation of the use of medical lasers in German hospitals

“…This is in line with a study that attributes a better outcome to these two procedures than to laser coagulation [39]. The already mentioned imprecise assignment of case numbers regarding the laser thermocoagulation technique should not or only marginally influence this pattern, since this technique is still very novel [40]. The last aspect considered in the results section of this study was the different types of lasers used in the clinics.…”

“…Thus, the linear regression can be interpreted as a long-term trend of the sinusoidal behavior. The already mentioned imprecise assignment of case numbers regarding the laser thermocoagulation technique should not or only marginally influence this pattern, since this technique is still very novel [40]. In order to determine whether this is a method specific trend or a trend affecting the coagulation technique in general, the case numbers of electrocoagulation, thermocoagulation and cryocoagulation were as well analyzed.…”

Stereotaktische Laserthermoablation bei mesialer Temporallappenepilepsie mit Hippocampussklerose rechts – Patientenentscheidung, Durchführung und Visualisierung von Gedächtnisfunktion

“…Seit die Methode 2011 in den Vereinigten Staaten eingeführt wurde, bestand seitens der Universitätsklinik für Neurologie [4] und Stereotaktische Neurochirurgie in Magdeburg aufgrund der minimalen Invasivität sowie aufgrund des sich anbahnenden Paradigmenwechsels durch den Einsatz der MR-Thermometrie ein hohes Interesse an der stereotaktischen Laserthermoablation. Nachdem erste Kasuistiken [5,7,10,13,15,30,35,36] aus Nordamerika eine kritische Auseinandersetzung mit den klinischen Ergebnissen erlaubten, wurde in Deutschland von unterschiedlichen Autoren über das Verfahren berichtet [17,23,26], und entsprechende Übersichtsarbeiten wurden publiziert [18,19]. Mit der CE-Zertifizierung am 10.04.2018 wurde die Be-handlungsoptionfürdenPatientenander Universitätsklinik Magdeburg erstmalig im deutschen Sprachraum konkret möglich.…”