Accurycy of Laser placement for LITT (Laser interstitial thermal therapy) using a customized stereotactic workflow
Lars Buentjen (Magdeburg), Martin Kanowski (Magdeburg), Friedhelm Schmitt (Magdeburg), Jörn Kaufmann (Magdeburg), Matthias Deliano (Magdeburg), Jürgen Voges (Magdeburg)
Laser Interstitiell Thermal Therapy is increasingly used to perform minimally invasive epilepsy surgery. While LITT (Visualase/ Medtronic) has been available in Europe for some years similar systems are becoming available. Despite the spreading use of such stereotactically steered devices little data is available on their ability to reach a predefined target point via a predetermined trajectory.However accuracy is mandatory as deep lying vessels impose risks for intracerebral bleeding and highly eloquent areas can be found adjacent to typical trajectories. Therefore this information is important to neurosurgeons in order to make decisions on risk management for this stereotactic precedure and to compare competing technologies.
We performed 30 LITT procedures for Epilepsy surgery. The ablation targets were the amygdaloid hippocampal complex, periventricular heterotopias, hypothalamic hamartomas and other epileptogenic entities. For the surgical placement a special stereotactic drill and screewing device was developed to avoid skiving in non rectangular drilling situations. Furthrmore a stepless transportation system was developed to ensure safe patient transport to the MRI suite with the implanted device. All procederes were performed with a MR compatible stereotactic frame in place.
Instrument insertion was controlled by stereotactic x-ray and MRI intraoperativly. We than retrospectivly analysed the radial and the euclidian distance of the Laser position in the intraoperative MRI, the stereotactic x-ray and the original treatment plan in 30 consecutive LITT cases.
Using a dedicated hardware configuration the mean radial distance, which is the relevant accuracy measure for thes procedure, was 1,57mm. Euclidian distance was 2,86mm reflecting different targetting strategies of the participating surgeons.
This technical study provides evidence for implantation accurycy of the Visualase™ Laser device. It implies that using a dedicated workflow yields results well comparable to other stereotactic procedures.
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