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Author Notes:

Correspondence: Jon T. Willie jontwillie@wustl.edu

KG and JW conceptualized the manuscript.

KG, AD, and JW wrote the manuscript.

RH and EF provided data.

All authors approved the final manuscript.

JW: Medtronic-consulting, research contract (SLATE trial), honoraria for teaching, Neuropace-consulting, research contract, honoraria for teaching, Clearpoint Neuro/MRI Interventions-consulting, AiM Medical-consulting.

EF has received research support from UCB Pharma, Xenon, Eisai, and the NINDS, and consulting fees from Biogen, Supernus, SKLife Science, and the CDC.

RH is involved with the Medtronic SLATE trial but receives no financial support.

The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Subjects:

Keywords:

  • temporal lobe epilepsy
  • LITT (laser interstitial thermal therapy)
  • ROSA (robotized stereotactic assistant)
  • temporal lobectomy
  • SEEG (stereoelectroencephalography)

Robot Assisted MRI-Guided LITT of the Anterior, Lateral, and Medial Temporal Lobe for Temporal Lobe Epilepsy

Tools:

Journal Title:

Frontiers in Neurology

Volume:

Volume 11

Publisher:

Type of Work:

Article | Final Publisher PDF

Abstract:

Robotic systems have fundamentally altered the landscape of functional neurosurgery. These allow automated stereotaxy with high accuracy and reliability, and are rapidly becoming a mainstay in stereotactic surgeries such as deep brain stimulation (DBS), stereoelectroencephalography (SEEG), and stereotactic laser ablation/MRI guided laser interstitial thermal therapy (MRgLITT). Robotic systems have been effectively applied to create a minimally invasive approach for diagnostics and therapeutics in the treatment of epilepsy, utilizing robots for expeditious and accurate stereotaxy for SEEG and MRgLITT. MRgLITT has been shown to approach open surgical techniques in efficacy of seizure control while minimizing collateral injury. We describe the use of robot assisted MRgLITT for a minimally invasive laser anterior temporal lobotomy, describing the approach and potential pitfalls. Goals of MRgLITT are complete ablation of the epileptogenic zone and avoiding injury to uninvolved structures. In the middle fossa these include structures such as cranial nerves in the skull base and cavernous sinus and the thalamus. These can be mitigated with careful trajectory planning and control of laser ablation intensity.

Copyright information:

© 2020 Gupta, Dickey, Hu, Faught and Willie.

This is an Open Access work distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/).
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