Intraclass Correlations of Measured Magnetic Resonance Imaging Volumes of Laser Interstitial Thermal Therapy‐Treated High‐Grade Gliomas

Purpose For chemotherapy to act synergistically and safely with radiation against high-grade gliomas, drugs must pass the endothelial junctions of the blood-tumor barrier (BTB) to reach all tumor cells, and should not pass the blood-brain barrier (BBB) to cause toxicity to normal brain. The objective of this study was to assess BBB/BTB status using magnetic resonance imaging (MRI) during a course of radiotherapy of high-grade gliomas. Patients and Methods Sixteen patients with grade 3 or 4 supratentorial malignant glioma receiving conformal radiotherapy (RT) underwent contrast-enhanced MRI before, during, and after completion of RT. A gadolinium diethylenetriaminepentaacetic acid (Gd-DTPA) uptake index was analyzed with respect to the tumor and RT dose received. Results In the nonenhanced tumor region, contrast uptake increased significantly after the receipt of approximately 10 Gy (P < .01), and reached a maximum after the receipt of approximately 30 Gy. In the initially contrast-enhanced tumor region, contrast uptake decreased over the course of RT and became significant after completion of RT in patients without progressive disease. The healthy brain showed only nonsignificant changes during and after irradiation. Conclusion Contrast MRI reveals increases in Gd-DTPA uptake in the initially nonenhanced tumor region but not in the remaining brain during the course of RT, suggesting opening of the BTB. This finding suggests that the effect of conformal radiation is more selective on the BTB than the BBB, and there may be a window extending from 1 week after the initiation of radiotherapy to 1 month after the completion of treatment during which a pharmaceutical agent has maximum access to high-grade gliomas.

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Laser Interstitial Thermal Therapy Technology, Physics of Magnetic Resonance Imaging Thermometry, and Technical Considerations for Proper Catheter Placement During Magnetic Resonance Imaging–Guided Laser Interstitial Thermal Therapy

Neurosurgery ◽

10.1227/neu.0000000000001440 ◽

2016 ◽

Vol 79 (suppl_1) ◽

pp. S8-S16 ◽

Cited By ~ 22

Author(s):

Nitesh V. Patel ◽

Matthew Mian ◽

R. Jason Stafford ◽

Brian V. Nahed ◽

Jon T. Willie ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Treatment Algorithm ◽

Thermal Therapy ◽

Catheter Placement ◽

Clear Understanding ◽

Resonance Imaging ◽

Laser Interstitial Thermal Therapy ◽

Basic Physics ◽

Intracranial Lesions

Abstract Laser-induced thermal therapy has become a powerful tool in the neurosurgical armamentarium. The physics of laser therapy are complex, but a sound understanding of this topic is clinically relevant, as many centers have incorporated it into their treatment algorithm, and educated patients are demanding consideration of its use for their disease. Laser ablation has been used for a wide array of intracranial lesions. Laser catheter placement is guided by stereotactic planning; however, as the procedure has popularized, the number of ways in which the catheter can be inserted has also increased. There are many technical nuances for laser placement, and, to date, there is not a clear understanding of whether any one technique is better than the other. In this review, we describe the basic physics of magnetic resonance–guided laser-induced thermal therapy and describe the several common techniques for accurate Visualase laser catheter placement in a stepwise fashion.

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Magnetic Resonance Imaging-Guided Focused Laser Interstitial Thermal Therapy for Subinsular Metastatic Adenocarcinoma: Technical Case Report

Operative Neurosurgery ◽

10.1227/neu.0b013e318232fc90 ◽

2011 ◽

Vol 70 (suppl_2) ◽

pp. onsE332-onsE338 ◽

Cited By ~ 10

Author(s):

Ammar H. Hawasli ◽

Wilson Z. Ray ◽

Rory K.J. Murphy ◽

Ralph G. Dacey ◽

Eric C. Leuthardt

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Image Guidance ◽

Gamma Knife Radiosurgery ◽

Thermal Therapy ◽

Intraoperative Mri ◽

Metastatic Adenocarcinoma ◽

Resonance Imaging ◽

Laser Interstitial Thermal Therapy ◽

Whole Brain Radiation

ABSTRACT BACKGROUND AND IMPORTANCE: To describe the novel use of the AutoLITT System (Monteris Medical, Winnipeg, Manitoba, Canada) for focused laser interstitial thermal therapy (LITT) with intraoperative magnetic resonance imaging (MRI) and stereotactic image guidance for the treatment of metastatic adenocarcinoma in the left insula. CLINICAL PRESENTATION: The patient was a 61-year-old right-handed man with a history of metastatic adenocarcinoma of the colon. He had previously undergone resection of multiple lesions, Gamma Knife radiosurgery, and whole-brain radiation. Despite treatment of a left insular tumor, serial imaging revealed that the lesion continued to enlarge. Given the refractory nature of this tumor to radiation and the deep-seated location, the patient elected to undergo LITT treatment. The center of the lesion and entry point on the scalp were identified with STEALTH (Medtronic, Memphis, Tennessee) image-guided navigation. The AXiiiS Stereotactic Miniframe (Monteris Medical) for the LITT system was secured onto the skull, and a trajectory was defined to achieve access to the centroid of the tumor. After a burr hole was made, a gadolinium template probe was inserted into the AXiiiS base. The trajectory was confirmed via an intraoperative MRI, and the LITT probe driver was attached to the base and CO2-cooled, side-firing laser LITT probe. The laser was activated and thermometry images were obtained. Two trajectories, posteromedial and anterolateral, produced satisfactory tumor ablation. CONCLUSION: LITT with intraoperative MRI and stereotactic image guidance is a newly available, minimally invasive, and therapeutically viable technique for the treatment of deep seated brain tumors.

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