Improved operative efficiency using a real-time MRI-guided stereotactic platform for laser amygdalohippocampotomy

Area of Science:

• Neurosurgery
• Medical Imaging
• Epilepsy Treatment

Background:

• MR-guided laser interstitial thermal therapy (MRgLITT) is a minimally invasive technique for tissue ablation.
• Selective amygdalohippocampal ablation is a treatment for temporal lobe epilepsy.
• Traditional MRgLITT may involve multiple procedural phases and locations.

Purpose of the Study:

• To evaluate the initial experience and feasibility of a real-time MRI-guided stereotactic platform for MRgLITT.
• To compare procedural times and outcomes of MRgLITT performed entirely in the MRI suite versus a traditional two-phase approach.

Main Methods:

• 17 patients with mesial temporal sclerosis underwent selective amygdalohippocampal ablation for temporal lobe epilepsy.
• The first 9 patients had standard laser ablation in two phases (OR and MRI suite).
• The subsequent 8 patients underwent the procedure entirely within the MRI suite using the ClearPoint platform.

Main Results:

• A learning curve was observed with the real-time MRI-guided system.
• Operative and total anesthesia times decreased linearly with experience.
• The MRI suite-only cohort demonstrated significantly shorter mean anesthesia times (327.2 ± 79.9 min) compared to the OR cohort (435.8 ± 78.4 min).
• Total mean patient procedure time was also reduced in the MRI suite-only cohort (362.8 ± 86.6 min) versus the OR cohort (456.9 ± 80.7 min).

Conclusions:

• The real-time MRI platform for MRgLITT is readily adoptable.
• Performing MRgLITT entirely within the MRI suite offers significant advantages in procedural efficiency.
• This approach may streamline treatment for temporal lobe epilepsy.