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Area of Science:

Neurosurgery
Medical Imaging
Computational Anatomy

Background:

Drug-resistant focal mesial temporal lobe epilepsy (MTLE) often requires surgical intervention.
Laser interstitial thermal therapy (LiTT) is a minimally invasive option for MTLE.
Current LiTT methods use straight-line trajectories, limiting precision for curved brain structures like the hippocampus and potentially causing collateral damage.

Purpose of the Study:

To investigate the clinical feasibility of curved LiTT trajectories using steerable needles.
To develop and evaluate a computer-assisted planning (CAP) algorithm for steerable needle-guided LiTT.

Main Methods:

A GPU-accelerated CAP algorithm was developed to generate optimized, curved 3D trajectories for steerable needles.
The algorithm aimed for maximal ablation of the amygdalohippocampal complex and minimal collateral damage, accommodating variable ablation diameters.
Simulations were performed on 5 patients with mesial temporal sclerosis (MTS).

Main Results:

The CAP algorithm successfully generated obstacle-free curved trajectories.
Compared to straight-line paths, curved trajectories achieved significantly greater target area ablation coverage.
The algorithm demonstrated lower parahippocampal gyrus (PHG) ablation variance, indicating reduced collateral damage.

Conclusions:

The developed CAP algorithm enhances ablation of the amygdalohippocampal complex in LiTT.
This approach results in lower patient risk scores compared to traditional straight-line trajectories.
Steerable needles show potential for improving both the efficacy and safety of LiTT procedures.