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Early MRI Characteristics after MRI-Guided Laser-Assisted Cingulotomy for Intractable Pain Control.

S H Sundararajan1, P Belani2, S Danish3

  • 1From the Department of Radiology (S.H.S., P.B.), Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey ssundararajan@univrad.com.

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|April 11, 2015
PubMed
Summary
This summary is machine-generated.

MR imaging-guided laser-assisted cingulotomy using a 980-nm diode laser shows distinct early "owl eye" changes in the cingulate gyri. These findings represent a continuum of thermal injury and aid in understanding post-procedure imaging.

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Area of Science:

  • Neurosurgery
  • Radiology
  • Pain Management

Background:

  • Cingulotomy is an established stereotactic procedure for treating severe pain syndromes.
  • Laser-assisted cingulotomy offers a minimally invasive approach.
  • The use of 980-nm diode laser for MR imaging-guided cingulotomy is novel.

Purpose of the Study:

  • To report early MR imaging changes following MR imaging-guided laser-assisted cingulotomy.
  • To characterize the distinct imaging patterns observed post-procedure.
  • To provide essential information for clinicians interpreting these changes.

Main Methods:

  • Retrospective analysis of 4 patients with intractable pain undergoing MR imaging-guided laser-assisted cingulotomy.
  • Patients underwent MR imaging at various time points post-procedure.
  • Visual analysis of MR imaging changes in the cingulate gyri was performed.

Main Results:

  • Twenty-four hours postablation, a characteristic "owl eye" pattern with four concentric rings was observed in the cingulate gyri.
  • These rings represent distinct zones of thermal injury, including fluid, hemorrhage, leaked protein, acute infarction, enhancement, and edema.
  • One patient showed persistent rings with resolved enhancement and edema at 1-year follow-up.

Conclusions:

  • The "owl eye" rings represent a continuum of laser and thermal injury.
  • Observed imaging changes are comparable to those seen with other laser ablation techniques.
  • This study provides the first characterization of early MR imaging changes after 980-nm laser-assisted cingulotomy, crucial for clinical interpretation.