Magnetic Resonance Imaging-Guided Laser Interstitial Thermal Therapy for Treatment of Drug-Resistant Epilepsy

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.

Download Full-text

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.

Download Full-text

Glioblastoma Treated With Magnetic Resonance Imaging-Guided Laser Interstitial Thermal Therapy: Safety, Efficacy, and Outcomes

Neurosurgery ◽

10.1093/neuros/nyy375 ◽

2018 ◽

Vol 84 (4) ◽

pp. 836-843 ◽

Cited By ~ 29

Author(s):

Ashwin A Kamath ◽

Daniel D Friedman ◽

S Hassan A Akbari ◽

Albert H Kim ◽

Yu Tao ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Thermal Therapy ◽

Resonance Imaging ◽

Laser Interstitial Thermal Therapy

Download Full-text

Magnetic Resonance Imaging-Guided Focused Laser Interstitial Thermal Therapy for Intracranial Lesions

Neurosurgery ◽

10.1227/neu.0000000000000144 ◽

2013 ◽

Vol 73 (6) ◽

pp. 1007-1017 ◽

Cited By ~ 117

Author(s):

Ammar H. Hawasli ◽

Swapnil Bagade ◽

Joshua S. Shimony ◽

Michelle Miller-Thomas ◽

Eric C. Leuthardt

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Treatment Option ◽

Progression Free Survival ◽

Thermal Therapy ◽

Seizure Freedom ◽

Resonance Imaging ◽

Laser Interstitial Thermal Therapy ◽

Imaging Characteristics ◽

Intracranial Lesions

Abstract BACKGROUND: Surgical treatments for deep-seated intracranial lesions have been limited by morbidities associated with resection. Real-time magnetic resonance imaging–guided focused laser interstitial thermal therapy (LITT) offers a minimally invasive surgical treatment option for such lesions. OBJECTIVE: To review treatments and results of patients treated with LITT for intracranial lesions at Washington University School of Medicine. METHODS: In a review of 17 prospectively recruited LITT patients (34–78 years of age; mean, 59 years), we report demographics, treatment details, postoperative imaging characteristics, and peri- and postoperative clinical courses. RESULTS: Targets included 11 gliomas, 5 brain metastases, and 1 epilepsy focus. Lesions were lobar (n = 8), thalamic/basal ganglia (n = 5), insular (n = 3), and corpus callosum (n = 1). Mean target volume was 11.6 cm3, and LITT produced 93% target ablation. Patients with superficial lesions had shorter intensive care unit stays. Ten patients experienced no perioperative morbidities. Morbidities included transient aphasia, hemiparesis, hyponatremia, deep venous thrombosis, and fatal meningitis. Postoperative magnetic resonance imaging showed blood products within the lesion surrounded by new thin uniform rim of contrast enhancement and diffusion restriction. In conjunction with other therapies, LITT targets often showed stable or reduced local disease. Epilepsy focus LITT produced seizure freedom at 8 months. Preliminary overall median progression-free survival and survival from LITT in tumor patients were 7.6 and 10.9 months, respectively. However, this small cohort has not been followed for a sufficient length of time, necessitating future outcomes studies. CONCLUSION: Early peri- and postoperative clinical data demonstrate that LITT is a safe and viable ablative treatment option for intracranial lesions, and may be considered for select patients.

Download Full-text