IEEE Laser interstitial thermal therapy (LiTT) is a minimally invasive alternative to conventional open surgery for drug-resistant focal mesial temporal lobe epilepsy (MTLE). Recent studies suggest that higher seizure freedom rates are correlated with maximal ablation of the mesial hippocampal head, whilst sparing of the parahippocampal gyrus (PHG) may reduce neuropsychological sequelae. Current commercially available laser catheters are inserted following manually planned straight-line trajectories, which cannot conform to curved brain structures, such as the hippocampus, without causing collateral damage or requiring multiple insertions. The clinical feasibility and potential of curved LiTT trajectories through steerable needles has yet to be investigated. This is the focus of our work. We propose a GPU-accelerated computer-assisted planning (CAP) algorithm for steerable needle insertions that generates optimized curved 3D trajectories with maximal ablation of the amygdalohippocampal complex and minimal collateral damage to nearby structures, while accounting for a variable ablation diameter ( $5-15mm$ ). Simulated trajectories and ablations were performed on 5 patients with mesial temporal sclerosis (MTS), which were identified from a prospectively managed database. The algorithm generated obstacle-free paths with significantly greater target area ablation coverage and lower PHG ablation variance compared to straight line trajectories. The presented CAP algorithm returns increased ablation of the amygdalohippocampal complex, with lower patient risk scores compared to straight-line trajectories. This is the first clinical application of preoperative planning for steerable needle based LiTT. This study suggests that steerable needles have the potential to improve LiTT procedure efficacy whilst improving the safety and should thus be investigated further.


    Access

    Download


    Export, share and cite



    Title :

    Computer Assisted Planning for Curved Laser Interstitial Thermal Therapy


    Contributors:
    Pinzi, M (author) / Hwang, B (author) / Vakharia, VN (author) / Duncan, JS (author) / Rodriguez y Baena, F (author) / Anderson, WS (author)

    Publication date :

    2021-01-01


    Remarks:

    IEEE Transactions on Biomedical Engineering (2021) (In press).


    Type of media :

    Article (Journal)


    Type of material :

    Electronic Resource


    Language :

    English


    Classification :

    DDC:    616 / 629



    Computer-assisted interstitial laser coagulation for BPH

    Ho, Gideon / Barrett, Adrian R. W. / Ng, Wan S. et al. | SPIE | 2001


    Computer assisted planning of tamping work

    Broomhead, S. F. / Tunna, J. M. / Wessex Institute of Technology | British Library Conference Proceedings | 1994


    Tile functionality of computer-assisted construction planning

    Rankin, J. H. / Froese, T. M. / Waugh, L. M. et al. | British Library Conference Proceedings | 1998


    Group Technology, Classification and Coding, Computer Assisted Process Planning and Computer Assisted Design Retrieval

    Houtzeel,A. / Org.for Ind.Res.Inc.,Massachusetts,US | Automotive engineering | 1984