Magnetic Resonance-Guided Laser Interstitial Thermal Therapy for Brain Tumors

AbstractIntroduction:Deep-seated hemispheric brain tumors pose unique challenges for surgical treatment. These tumors are often considered inoperable and when surgery is undertaken significant, serious, morbidity and even mortality may complicate the outcome. Laser interstitial thermal therapy (LITT) is a minimally invasive alternative to traditional open surgery that affects tumor cell death by producing a zone of thermal tissue damage that can be monitored and controlled with the aid of real-time magnetic resonance thermography.Subjects and methods:A retrospective review of six patients treated with LITT at the Cleveland Clinic between 5/2011 and 8/2013 was performed. We evaluated clinical patient data and pre-, intra-, and post-operative magnetic resonance imaging (MRI) data for correlation.Results:Six patients were treated with a total of eight separate LITT procedures for their thalamic (n=5) or basal ganglia (n=1) tumors. All tumors were histologically malignant and five were primary tumors. Pre- and post-operative neurological deficits were recorded. The two patients that underwent multiple procedures were retreated for different reasons – one due to insufficient coverage and the other due to tumor recurrence. Sustained post-operative neurological deficits were observed after three procedures and one patient died within 2 days of surgery from a thalamic hemorrhage.Conclusions:LITT is a minimally invasive surgical treatment that can lead to successful ablation of tumors of the thalamus or basal ganglia. However, this treatment has the potential for neurological morbidity or even mortality and as such further studies are needed to evaluate the true risk vs. reward potential for LITT with regard to treating deep-seated tumors.

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Magnetic Resonance Thermometry and Laser Interstitial Thermal Therapy for Brain Tumors

Neurosurgery Clinics of North America ◽

10.1016/j.nec.2017.05.015 ◽

2017 ◽

Vol 28 (4) ◽

pp. 525-533 ◽

Cited By ~ 15

Author(s):

Danilo Silva ◽

Mayur Sharma ◽

Rupa Juthani ◽

Antonio Meola ◽

Gene H. Barnett

Keyword(s):

Magnetic Resonance ◽

Brain Tumors ◽

Thermal Therapy ◽

Magnetic Resonance Thermometry ◽

Laser Interstitial Thermal Therapy

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Magnetic resonance–guided laser interstitial thermal therapy: report of a series of pediatric brain tumors

Journal of Neurosurgery Pediatrics ◽

10.3171/2015.11.peds15242 ◽

2016 ◽

Vol 17 (6) ◽

pp. 723-733 ◽

Cited By ~ 29

Author(s):

Zulma Tovar-Spinoza ◽

Hoon Choi

Keyword(s):

Magnetic Resonance ◽

Brain Tumors ◽

Pediatric Brain Tumors ◽

Thermal Therapy ◽

Laser Interstitial Thermal Therapy ◽

Children's Hospital ◽

Different Types ◽

Children’S Hospital ◽

The Mean ◽

Pediatric Brain

OBJECTIVE Magnetic resonance–guided laser interstitial thermal therapy (MRgLITT) is a novel, minimally invasive treatment that has multiple advantages in pediatric use and broad applicability for different types of lesions. Here, the authors report the preliminary results of the first series of pediatric brain tumors treated with MRgLITT at Golisano Children's Hospital in Syracuse, New York. METHODS Pediatric brain tumors treated with MRgLITT between February 2012 and August 2014 at Golisano Children's Hospital were evaluated retrospectively. Medical records, radiological findings, surgical data, complications, and results of tumor volumetric analyses were reviewed. The Visualase thermal laser system (Medtronic) was used in all MRgLITT procedures. RESULTS This series included 11 patients with 12 tumors (pilocytic astrocytoma, ependymoma, medulloblastoma, choroid plexus xanthogranuloma, subependymal giant cell astrocytoma, and ganglioglioma). A single laser and multiple overlapping ablations were used for all procedures. The mean laser dose was 10.23 W, and the mean total ablation time was 68.95 seconds. The mean initial target volume was 6.79 cm3, and the mean immediate post-ablation volume was 7.86 cm3. The mean hospital stay was 3.25 days, and the mean follow-up time was 24.5 months. Tumor volume decreased in the first 3 months after surgery (n = 11; p = 0.007) and continued to decrease by the 4- to 6-month followup (n = 11; mean volume 2.61 cm3; p = 0.009). Two patients experienced post-ablation complications: transient right leg weakness in one patient, and transient hemiparesis, akinetic mutism, and eye movement disorder in the other. CONCLUSIONS Magnetic resonance–guided laser interstitial thermal therapy is an effective first- or second-line treatment for select pediatric brain tumors. Larger multiinstitutional clinical trials are necessary to evaluate its use for different types of lesions to further standardize practices.

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Non-robotized frameless stereotactic magnetic resonance guided laser interstitial thermal therapy for hypothalamic hamartoma: preliminary results of 2 cases and review of the literature

Journal of Neurosurgical Sciences ◽

10.23736/s0390-5616.21.05442-4 ◽

2021 ◽

Author(s):

Giuseppe DI PERNA ◽

Mattia PACETTI ◽

Domenico TORTORA ◽

Lino NOBILI ◽

Armando CAMA ◽

...

Keyword(s):

Magnetic Resonance ◽

Thermal Therapy ◽

Hypothalamic Hamartoma ◽

Review Of The Literature ◽

Preliminary Results ◽

Laser Interstitial Thermal Therapy

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Does the Modified Arrhenius Model Reliably Predict Area of Tissue Ablation After Magnetic Resonance-Guided Laser Interstitial Thermal Therapy for Pediatric Lesional Epilepsy?

Operative Neurosurgery ◽

10.1093/ons/opab225 ◽

2021 ◽

Author(s):

Kelsey D Cobourn ◽

Imazul Qadir ◽

Islam Fayed ◽

Hepzibha Alexander ◽

Chima O Oluigbo

Keyword(s):

Magnetic Resonance ◽

Linear Regression ◽

Magnetic Resonance Images ◽

Thermal Therapy ◽

Invasive Technique ◽

Hypothalamic Hamartoma ◽

Arrhenius Model ◽

Laser Interstitial Thermal Therapy ◽

Accuracy And Precision

Abstract BACKGROUND Commercial magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) systems utilize a generalized Arrhenius model to estimate the area of tissue damage based on the power and time of ablation. However, the reliability of these estimates in Vivo remains unclear. OBJECTIVE To determine the accuracy and precision of the thermal damage estimate (TDE) calculated by commercially available MRgLITT systems using the generalized Arrhenius model. METHODS A single-center retrospective review of pediatric patients undergoing MRgLITT for lesional epilepsy was performed. The area of each lesion was measured on both TDE and intraoperative postablation, postcontrast T1 magnetic resonance images using ImageJ. Lesions requiring multiple ablations were excluded. The strength of the correlation between TDE and postlesioning measurements was assessed via linear regression. RESULTS A total of 32 lesions were identified in 19 patients. After exclusion, 13 pairs were available for analysis. Linear regression demonstrated a strong correlation between estimated and actual ablation areas (R2 = .97, P < .00001). The TDE underestimated the area of ablation by an average of 3.92% overall (standard error (SE) = 4.57%), but this varied depending on the type of pathologic tissue involved. TDE accuracy and precision were highest in tubers (n = 3), with average underestimation of 2.33% (SE = 0.33%). TDE underestimated the lesioning of the single hypothalamic hamartoma in our series by 52%. In periventricular nodular heterotopias, TDE overestimated ablation areas by an average of 13% (n = 2). CONCLUSION TDE reliability is variably consistent across tissue types, particularly in smaller or periventricular lesions. Further investigation is needed to understand the accuracy of this emerging minimally invasive technique.

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