Stereotactic robot-assisted MRI-guided laser thermal ablation of radiation necrosis in the posterior cranial fossa: technical note

被引:22
作者
Chan, Alvin Y. [2 ]
Tran, Diem Kieu T. [1 ]
Gill, Amandip S. [1 ]
Hsu, Frank P. K. [1 ]
Vadera, Sumeet [1 ]
机构
[1] Univ Calif Irvine, Dept Neurol Surg, Irvine, CA USA
[2] Med Coll Wisconsin, Dept Neurosurg, Milwaukee, WI 53226 USA
关键词
infratentorial LITT; laser interstitial thermal therapy; minimally invasive; ROSA; robotic assistance; THERAPY; TECHNOLOGY; ACCURACY; EPILEPSY; LITT;
D O I
10.3171/2016.4.FOCUS1622
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Laser interstitial thermal therapy (LITT) is a minimally invasive procedure used to treat a variety of intracranial lesions. Utilization of robotic assistance with stereotactic procedures has gained attention due to potential for advantages over conventional techniques. The authors report the first case in which robot-assisted MRI-guided LITT was used to treat radiation necrosis in the posterior fossa, specifically within the cerebellar peduncle. The use of a stereotactic robot allowed the surgeon to perform LITT using a trajectory that would be extremely difficult with conventional arc-based techniques. A 60-year-old man presented with facial weakness and brainstem symptoms consistent with radiation necrosis. He had a history of anaplastic astrocytoma that was treated with CyberKnife radiosurgery 1 year prior to presentation, and he did well for 11 months until his symptoms recurred. The location and form of the lesion precluded excision but made the patient a suitable candidate for LITT. The location and configuration of the lesion required a trajectory for LITT that was too low for arc-based stereotactic navigation, and thus the ROSA robot (Medtech) was used. Using preoperative MRI acquisitions, the lesion in the posterior fossa was targeted. Bone fiducials were used to improve accuracy in registration, and the authors obtained an intraoperative CT image that was then fused with the MR image by the ROSA robot. They placed the laser applicator and then ablated the lesion under real-time MR thermometry. There were no complications, and the patient tolerated the procedure well. Postoperative 2-month MRI showed complete resolution of the lesion, and the patient had some improvement in symptoms.
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页数:4
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