Intraoperative MRI Assessment of the Tissue Damage during Laser Ablation of Hypothalamic Hamartoma
Laser ablation for treatment of hypothalamic hamartoma (HH) is a minimally invasive and effective technique used to destroy hamartomatous tissue and disconnect it from the functioning brain. Currently, the gold standard to evaluate the amount of tissue being “burned” is the use of heat maps during t...
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-07-01
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| Series: | Diagnostics |
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| Online Access: | https://www.mdpi.com/2075-4418/13/14/2331 |
| _version_ | 1827733322667655168 |
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| author | Sophie Lombardi Domenico Tortora Stefania Picariello Sniya Sudhakar Enrico De Vita Kshitij Mankad Sophia Varadkar Alessandro Consales Lino Nobili Jessica Cooper Martin M. Tisdall Felice D’Arco |
| author_facet | Sophie Lombardi Domenico Tortora Stefania Picariello Sniya Sudhakar Enrico De Vita Kshitij Mankad Sophia Varadkar Alessandro Consales Lino Nobili Jessica Cooper Martin M. Tisdall Felice D’Arco |
| author_sort | Sophie Lombardi |
| collection | DOAJ |
| description | Laser ablation for treatment of hypothalamic hamartoma (HH) is a minimally invasive and effective technique used to destroy hamartomatous tissue and disconnect it from the functioning brain. Currently, the gold standard to evaluate the amount of tissue being “burned” is the use of heat maps during the ablation procedure. However, these maps have low spatial resolution and can be misleading in terms of extension of the tissue damage. The aim of this study is to use different MRI sequences immediately after each laser ablation and correlate the extension of signal changes with the volume of malacic changes in a long-term follow-up scan. During the laser ablation procedure, we imaged the hypothalamic region with high-resolution axial diffusion-weighted images (DWI) and T2-weighted images (T2WI) after each ablation. At the end of the procedure, we also added a post-contrast T1-weighted image (T1WI) of the same region. We then correlated the product of the maximum diameters on axial showing signal changes (acute oedema on T2WI, DWI restriction rim, DWI hypointense core and post-contrast T1WI rim) with the product of the maximum diameters on axial T2WI of the malacic changes in the follow-up scan, both as a fraction of the total area of the hamartoma. The area of the hypointense core on DWI acquired immediately after the laser ablation statistically correlated better with the final area of encephalomalacia, while the T2WI, hyperintense oedema, DWI rim and T1WI rim of enhancement tended to overestimate the encephalomalacic damage. In conclusion, the use of intraoperative sequences (in particular DWI) during laser ablation can give surgeons valuable information in real time about the effective heating damage on the hamartomatous tissue, with better spatial resolution in comparison to the thermal maps. |
| first_indexed | 2024-03-11T01:09:50Z |
| format | Article |
| id | doaj.art-8949ba996e074a768d3da84f18b17877 |
| institution | Directory Open Access Journal |
| issn | 2075-4418 |
| language | English |
| last_indexed | 2024-03-11T01:09:50Z |
| publishDate | 2023-07-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Diagnostics |
| spelling | doaj.art-8949ba996e074a768d3da84f18b178772023-11-18T18:57:12ZengMDPI AGDiagnostics2075-44182023-07-011314233110.3390/diagnostics13142331Intraoperative MRI Assessment of the Tissue Damage during Laser Ablation of Hypothalamic HamartomaSophie Lombardi0Domenico Tortora1Stefania Picariello2Sniya Sudhakar3Enrico De Vita4Kshitij Mankad5Sophia Varadkar6Alessandro Consales7Lino Nobili8Jessica Cooper9Martin M. Tisdall10Felice D’Arco11Radiodiagnostic Department, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, ItalyNeuroradiology Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, ItalyNeuro-Oncology Unit, Department of Paediatric Oncology, Santobono-Pausilipon Children’s Hospital, 80123 Naples, ItalyGreat Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UKGreat Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UKGreat Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UKGreat Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UKDepartment of Surgical Sciences, Division of Neurosurgery, IRCCS Istituto Giannina Gaslini, 16147 Genoa, ItalyChild Neuropsychiatry Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, ItalyGreat Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UKGreat Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UKGreat Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UKLaser ablation for treatment of hypothalamic hamartoma (HH) is a minimally invasive and effective technique used to destroy hamartomatous tissue and disconnect it from the functioning brain. Currently, the gold standard to evaluate the amount of tissue being “burned” is the use of heat maps during the ablation procedure. However, these maps have low spatial resolution and can be misleading in terms of extension of the tissue damage. The aim of this study is to use different MRI sequences immediately after each laser ablation and correlate the extension of signal changes with the volume of malacic changes in a long-term follow-up scan. During the laser ablation procedure, we imaged the hypothalamic region with high-resolution axial diffusion-weighted images (DWI) and T2-weighted images (T2WI) after each ablation. At the end of the procedure, we also added a post-contrast T1-weighted image (T1WI) of the same region. We then correlated the product of the maximum diameters on axial showing signal changes (acute oedema on T2WI, DWI restriction rim, DWI hypointense core and post-contrast T1WI rim) with the product of the maximum diameters on axial T2WI of the malacic changes in the follow-up scan, both as a fraction of the total area of the hamartoma. The area of the hypointense core on DWI acquired immediately after the laser ablation statistically correlated better with the final area of encephalomalacia, while the T2WI, hyperintense oedema, DWI rim and T1WI rim of enhancement tended to overestimate the encephalomalacic damage. In conclusion, the use of intraoperative sequences (in particular DWI) during laser ablation can give surgeons valuable information in real time about the effective heating damage on the hamartomatous tissue, with better spatial resolution in comparison to the thermal maps.https://www.mdpi.com/2075-4418/13/14/2331gelastic epilepsyhypothalamic hamartomaMRgLITTstereotactic laser ablationintraoperative MRIepilepsy surgery |
| spellingShingle | Sophie Lombardi Domenico Tortora Stefania Picariello Sniya Sudhakar Enrico De Vita Kshitij Mankad Sophia Varadkar Alessandro Consales Lino Nobili Jessica Cooper Martin M. Tisdall Felice D’Arco Intraoperative MRI Assessment of the Tissue Damage during Laser Ablation of Hypothalamic Hamartoma Diagnostics gelastic epilepsy hypothalamic hamartoma MRgLITT stereotactic laser ablation intraoperative MRI epilepsy surgery |
| title | Intraoperative MRI Assessment of the Tissue Damage during Laser Ablation of Hypothalamic Hamartoma |
| title_full | Intraoperative MRI Assessment of the Tissue Damage during Laser Ablation of Hypothalamic Hamartoma |
| title_fullStr | Intraoperative MRI Assessment of the Tissue Damage during Laser Ablation of Hypothalamic Hamartoma |
| title_full_unstemmed | Intraoperative MRI Assessment of the Tissue Damage during Laser Ablation of Hypothalamic Hamartoma |
| title_short | Intraoperative MRI Assessment of the Tissue Damage during Laser Ablation of Hypothalamic Hamartoma |
| title_sort | intraoperative mri assessment of the tissue damage during laser ablation of hypothalamic hamartoma |
| topic | gelastic epilepsy hypothalamic hamartoma MRgLITT stereotactic laser ablation intraoperative MRI epilepsy surgery |
| url | https://www.mdpi.com/2075-4418/13/14/2331 |
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