Combined Surgical Resection and Laser Interstitial Thermal Therapy for Glioblastoma: Technical Note

2020 ◽  
Vol 81 (04) ◽  
pp. 348-354
Author(s):  
Rafael A. Vega ◽  
Jeffrey I. Traylor ◽  
Rajan Patel ◽  
Matthew Muir ◽  
Dheigo C.A. Bastos ◽  
...  
Keyword(s):  
Surgical Resection ◽  
Malignant Gliomas ◽  
Length Of Hospital Stay ◽  
Residual Tumor ◽  
Technical Note ◽  
Thermal Therapy ◽  
Cancer Center ◽  
Invasive Technique ◽  
Laser Interstitial Thermal Therapy

Abstract Background Glioblastoma multiforme (GBM) is an aggressive intracranial malignancy that confers a poor prognosis despite maximum surgical resection and chemoradiotherapy. Survival decreases further with deep-seated lesions. Laser interstitial thermal therapy (LITT) is an emerging minimally invasive technique for tumor ablation shown to reduce tumor burden effectively, particularly in deep-seated locations less amenable to gross total resection. We describe our initial technical experience of using the combination of LITT followed by surgical resection in patients with GBMs that exhibit both an easily accessible and deep-seated component. Materials and Methods Patients with GBM who received concurrent LITT and surgical resection at our institution were identified. Patient demographic and clinical information was procured from the University of Texas MD Anderson Cancer Center electronic medical record along with preoperative, postoperative, and 1-month follow-up magnetic resonance imaging (MRI). Results Four patients (n = 2 male, n = 2 female) with IDH-wild type GBM who received combined LITT and surgical resection were identified and analyzed retrospectively. All patients received chemoradiotherapy before presentation. All but one patient (75%) received resection before presentation. Median age was 54 years (range: 44–56 years). Median length of hospital stay was 6.5 days (range: 2–47 days). Median extent of combined ablation/resection was 90.4%. One of the four patients experienced complications in the perioperative or immediate follow-up periods. Local recurrence was observed in one patient during the follow-up period. Conclusion Malignant gliomas in deep-seated locations or in close proximity to white matter structures are challenging to manage. LITT followed by surgical resection may provide an alternative for tumor debulking that minimizes potential morbidities and extent of residual tumor. Further studies comparing this approach with standard resection techniques are warranted.

Staged Magnetic Resonance-Guided Laser Interstitial Thermal Therapy for Hypothalamic Hamartoma: Analysis of Ablation Volumes and Morphological Considerations

Neurosurgery ◽  
2019 ◽  
Vol 86 (6) ◽  
pp. 808-816 ◽  
Author(s):  
Nisha Gadgil ◽  
Sandi Lam ◽  
I-Wen Pan ◽  
Melissa LoPresti ◽  
Kathryn Wagner ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Thermal Therapy ◽  
Invasive Technique ◽  
Seizure Outcome ◽  
Seizure Freedom ◽  
Gelastic Seizures ◽  
Laser Interstitial Thermal Therapy ◽  
Significant Difference ◽  
The Impact

Abstract BACKGROUND Hypothalamic hamartomas (HH) are a challenging pathology that cause gelastic seizures. Magnetic Resonance Imaging-guided Laser Interstitial Thermal Therapy (MRgLITT) offers a safe and effective treatment for HHs via a minimally invasive technique. OBJECTIVE To determine how clinical outcome correlates to residual tumor volume and surgical strategy by analyzing radiographic data and reconstructing volumetric imaging. METHODS Clinical and radiographic information of 58 pediatric patients who underwent MRgLITT for HH with at least 6 mo of follow-up were retrospectively reviewed. MR imaging was volumetrically reconstructed to analyze the impact of hamartoma and ablation volumes on outcome. Primary outcome measure was freedom from gelastic seizures. RESULTS Eighty-one percent of patients were completely free of gelastic seizures at last follow-up; of 22 patients with secondary nongelastic epilepsy, 15 were free of additional seizures. Postoperative complication rate was low. There was no significant difference in gelastic seizure outcome related to pre- or postoperative hamartoma size. Residual hamartoma percentage in those free of gelastic seizures was 43% compared to 71% in those with continued seizures (P = .021). Larger hamartomas required multiple ablations to achieve seizure freedom. CONCLUSION This large series of patients confirms the safety and efficacy of MRgLITT for pediatric HH and describes morphological considerations that predict success. Our data suggest that complete ablation of the lesion is not necessary, and that the focus should be on appropriate disconnection of the epileptogenic network. We have found that a staged approach to hamartoma ablation allows adequate disconnection of the hamartoma while mitigating risk to surrounding structures.

Prognostic factors of overall survival after laser interstitial thermal therapy in patients with glioblastoma

2014 ◽  
Vol 3 (2) ◽  
Author(s):  
Symeon Missios ◽  
Jason L. Schroeder ◽  
Gene H. Barnett ◽  
Alireza M. Mohammadi
Keyword(s):  
Overall Survival ◽  
Cleveland Clinic ◽  
Progression Free Survival ◽  
Thermal Therapy ◽  
Invasive Technique ◽  
Free Survival ◽  
Laser Interstitial Thermal Therapy ◽  
Effective Manner ◽  
Improve Patient

AbstractBackground:Laser interstitial thermal therapy (LITT) is a minimally invasive technique for treating intracranial tumors percutaneously. Controlled thermal damage to the tumor may offer an adjunct to the treatment of glioblastoma multiforme (GBM) especially in deep-seated locations. We report our series of patients with GBM treated with LITT.Methods:Eleven consecutive patients with GBM who underwent LITT at the Cleveland Clinic using the NeuroBlateResults:LITT was delivered as upfront treatment in six cases and delivered as salvage in five cases. After 26.2 months of follow-up, 73% of cases demonstrated progression and 54.5% died. The median overall survival (OS) for the cohort was 8.4 months. Median progression free survival (PFS) was 6.1 months. A tendency towards improved overall survival was discovered in patients who had near complete coverage of tumor by blue and yellow TDT-lines.Conclusions:LITT can be used in a safe and effective manner for the treatment of patients with difficult to access GBM. Improved coverage of the tumor by the TDT-treatment lines has a tendency to improve patient overall survival.

scholarly journals SURG-13. LASER INTERSTITIAL THERMAL THERAPY FOR RECURRENT GLIOBLASTOMA: A REVIEW OF SURVIVAL OUTCOMES COMPARED TO A MATCHED SURGICAL COHORT

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii206-ii206
Author(s):  
Hassan Fadel ◽  
Sameah Haider ◽  
Jacob Pawloski ◽  
Hesham Zakaria ◽  
Farhan Chaudhry ◽  
...  
Keyword(s):  
Surgical Resection ◽  
Subgroup Analysis ◽  
Tumor Volume ◽  
Progression Free Survival ◽  
Recurrent Glioblastoma ◽  
Thermal Therapy ◽  
Survival Outcomes ◽  
Repeat Surgery ◽  
Laser Interstitial Thermal Therapy ◽  
Recurrent Gbm

Abstract INTRODUCTION Glioblastoma (GBM) is uniformly associated with a poor prognosis and inevitable recurrence. Management of recurrent GBM remains unclear, with repeat surgery often employed with varying degrees of success. We evaluated the efficacy of Laser Interstitial Thermal Therapy (LITT) for recurrent GBM when compared to a carefully matched cohort of patients treated with repeat surgical resection. METHODS A retrospective single-institution database was used to identify patients who underwent LITT or surgical resection of recurrent GBM between 2014-2019. LITT patients were matched with surgical resection patients according to baseline demographics, comorbidities, tumor location, and eloquence. Subgroup analysis matching similar patients for tumor volume was also completed. Overall survival (OS) and progression-free survival (PFS) were the primary endpoints. RESULTS A LITT cohort of 20 patients was matched to 50 similar patients who underwent repeat surgical resection. Baseline characteristics were similar between both cohorts apart from tumor volume, which was larger in the surgical cohort (17.5 cc vs. 4.7 cc, p< 0.01). On long-term follow-up, there was no difference in OS (HR, 0.72; 95%CI, 0.36-1.45) or PFS (HR, 0.67; 95%CI, 0.29-1.53) between the LITT and surgical cohorts when controlling for tumor volume. Subgroup analysis of 23 LITT patients matched according to tumor volume with 23 surgical patients with similar clinical characteristics also found no difference in OS (HR, 0.66; 95%CI, 0.33-1.30) or PFS (HR, 0.58; 95%CI, 0.90-1.05) between the cohorts. LITT patients had shorter length of stays (1 vs. 4 days, p< 0.001) and a higher rate of home discharge (84% vs. 67%, p=0.172) compared to the surgical cohort. CONCLUSION After matching for demographic, clinical, and tumor characteristics, there was no difference in outcomes between patients undergoing LITT compared to surgical resection for recurrent GBM. LITT patients had similar survival outcomes yet shorter hospital stays and more favorable dispositions, potentially mitigating post-treatment complications.

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

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.

scholarly journals Laser interstitial thermal therapy for subependymal giant cell astrocytoma: technical case report

2016 ◽  
Vol 41 (4) ◽  
pp. E9 ◽  
Author(s):  
David Y. A. Dadey ◽  
Ashwin A. Kamath ◽  
Eric C. Leuthardt ◽  
Matthew D. Smyth
Keyword(s):  
Giant Cell ◽  
Pediatric Population ◽  
Thermal Therapy ◽  
Subependymal Giant Cell Astrocytoma ◽  
Complication Rates ◽  
Open Resection ◽  
Laser Interstitial Thermal Therapy ◽  
Intracranial Lesions ◽  
Giant Cell Astrocytoma

Subependymal giant cell astrocytoma (SEGA) is a rare tumor occurring almost exclusively in patients with tuberous sclerosis complex. Although open resection remains the standard therapy, complication rates remain high. To minimize morbidity, less invasive approaches, such as endoscope-assisted resection, radiosurgery, and chemotherapy with mTOR pathway inhibitors, are also used to treat these lesions. Laser interstitial thermal therapy (LITT) is a relatively new modality that is increasingly used to treat a variety of intracranial lesions. In this report, the authors describe two pediatric cases of SEGA that were treated with LITT. In both patients the lesion responded well to this treatment modality, with tumor shrinkage observed on follow-up MRI. These cases highlight the potential of LITT to serve as a viable minimally invasive therapeutic approach to the management of SEGAs in the pediatric population.

scholarly journals Clinical Outcomes and Multidisciplinary Patterns of Failure for Olfactory Neuroblastoma: The Ohio State Experience

2019 ◽  
Vol 81 (03) ◽  
pp. 287-294 ◽  
Author(s):  
Adam R. Wolfe ◽  
Dukagjin Blakaj ◽  
Nyall London ◽  
Adriana Blakaj ◽  
Brett Klamer ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Surgical Resection ◽  
Cox Regression ◽  
Disease Free Survival ◽  
Olfactory Neuroblastoma ◽  
Cancer Center ◽  
Treatment Intensification ◽  
Cox Regression Analysis ◽  
Failure Patterns

Purpose Olfactory neuroblastoma (ONB) is a rare head and neck cancer believed to be originated from neural crest cells of the olfactory membrane located in the roof of the nasal fossa. This study evaluates clinical outcomes and failure patterns in ONB patients of those patients treated with surgical resection at a high-volume tertiary cancer center. Methods and Materials Thirty-nine ONB patients who underwent surgical resection at our institution from 1996 to 2017 were retrospectively identified. Univariate, multivariate, and survival analysis were calculated using Cox regression analysis and Kaplan–Meier log-rank. Results Median follow-up time was 59 months (range: 5.2–236 months). The median overall survival (OS) and disease-free survival (DFS) for the entire cohort were 15 and 7.6 years, respectively. The 5-year cumulative OS and DFS were 83 and 72%, respectively. The 5-year OS for low Hyams grade (LHG) versus high Hyams grade (HHG) was 95 versus 61% (p = 0.041). LHG was found in 66% of the early Kadish stage patients compared with 28% in the advanced Kadish stage patients (p = 0.057). On multivariate analysis, HHG and positive node status predicted for worse OS and only HHG predicted for worse DFS. Of note, five patients (all Kadish stage A) who received surgical resection alone had no observed deaths or recurrences with a median follow-up of 44 months (range: 5–235 months). Conclusion In this retrospective cohort, patients with positive nodes or HHG have significantly worse clinical outcomes. Future studies should explore treatment intensification for HHG or positive nodes.

scholarly journals Neurosurgical applications of MRI guided laser interstitial thermal therapy (LITT)

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Usama Salem ◽  
Vinodh A. Kumar ◽  
John E. Madewell ◽  
Donald F. Schomer ◽  
Dhiego Chaves de Almeida Bastos ◽  
...  
Keyword(s):  
Treatment Options ◽  
Thermal Therapy ◽  
Invasive Technique ◽  
Laser Device ◽  
Invasive Treatment ◽  
Laser Interstitial Thermal Therapy ◽  
Alternative Treatment Option ◽  
Selective Ablation ◽  
Potential Applications ◽  
Mri Guided

Abstract MRI-guided laser interstitial thermal therapy (LITT) is the selective ablation of a lesion or a tissue using heat emitted from a laser device. LITT is considered a less invasive technique compared to open surgery that provides a nonsurgical solution for patients who cannot tolerate surgery. Although laser ablation has been used to treat brain lesions for decades, recent advances in MRI have improved lesion targeting and enabled real-time accurate monitoring of the thermal ablation process. These advances have led to a plethora of research involving the technique, safety, and potential applications of LITT. LITT is a minimally invasive treatment modality that shows promising results and is associated with decreased morbidity. It has various applications, such as treatment of glioma, brain metastases, radiation necrosis, and epilepsy. It can provide a safer alternative treatment option for patients in whom the lesion is not accessible by surgery, who are not surgical candidates, or in whom other standard treatment options have failed. Our aim is to review the current literature on LITT and provide a descriptive review of the technique, imaging findings, and clinical applications for neurosurgery.

scholarly journals Magnetic resonance imaging–guided laser interstitial thermal therapy as treatment for intractable insular epilepsy in children

2017 ◽  
Vol 20 (6) ◽  
pp. 575-582 ◽  
Author(s):  
M. Scott Perry ◽  
David J. Donahue ◽  
Saleem I. Malik ◽  
Cynthia G. Keator ◽  
Angel Hernandez ◽  
...  
Keyword(s):  
Epilepsy Surgery ◽  
Medical Center ◽  
Surgical Techniques ◽  
Intractable Epilepsy ◽  
Vascular Supply ◽  
Thermal Therapy ◽  
Attractive Alternative ◽  
Class Iii ◽  
Laser Interstitial Thermal Therapy

OBJECTIVESeizure onset within the insula is increasingly recognized as a cause of intractable epilepsy. Surgery within the insula is difficult, with considerable risks, given the rich vascular supply and location near critical cortex. MRI-guided laser interstitial thermal therapy (LiTT) provides an attractive treatment option for insular epilepsy, allowing direct ablation of abnormal tissue while sparing nearby normal cortex. Herein, the authors describe their experience using this technique in a large cohort of children undergoing treatment of intractable localization-related epilepsy of insular onset.METHODSThe combined epilepsy surgery database of Cook Children’s Medical Center and Dell Children’s Hospital was queried for all cases of insular onset epilepsy treated with LiTT. Patients without at least 6 months of follow-up data and cases preoperatively designated as palliative were excluded. Patient demographics, presurgical evaluation, surgical plan, and outcome were collected from patient charts and described.RESULTSTwenty patients (mean age 12.8 years, range 6.1–18.6 years) underwent a total of 24 LiTT procedures; 70% of these patients had normal findings on MRI. Patients underwent a mean follow-up of 20.4 months after their last surgery (range 7–39 months), with 10 (50%) in Engel Class I, 1 (5%) in Engel Class II, 5 (25%) in Engel Class III, and 4 (20%) in Engel Class IV at last follow-up. Patients were discharged within 24 hours of the procedure in 15 (63%) cases, in 48 hours in 6 (24%) cases, and in more than 48 hours in the remaining cases. Adverse functional effects were experienced following 7 (29%) of the procedures: mild hemiparesis after 6 procedures (all patients experienced complete resolution or had minimal residual dysfunction by 6 months), and expressive language dysfunction after 1 procedure (resolved by 3 months).CONCLUSIONSTo their knowledge, the authors present the largest cohort of pediatric patients undergoing insular surgery for treatment of intractable epilepsy. The patient outcomes suggest that LiTT can successfully treat intractable seizures originating within the insula and offers an attractive alternative to open resection. This is the first description of LiTT applied to insular epilepsy and represents one of only a few series describing the use of LiTT in children. The results indicate that seizure reduction after LiTT compares favorably to that after conventional open surgical techniques.

scholarly journals Open Resection versus Laser Interstitial Thermal Therapy for the Treatment of Pediatric Insular Epilepsy

Neurosurgery ◽  
2019 ◽  
Vol 85 (4) ◽  
pp. E730-E736 ◽  
Author(s):  
Andrew T Hale ◽  
Sonali Sen ◽  
Ali S Haider ◽  
Freedom F Perkins ◽  
Dave F Clarke ◽  
...  
Keyword(s):  
Surgical Resection ◽  
Pediatric Patients ◽  
Average Length ◽  
Insular Cortex ◽  
Thermal Therapy ◽  
Seizure Freedom ◽  
Complication Rates ◽  
Open Resection ◽  
Management Options ◽  
Laser Interstitial Thermal Therapy

AbstractBACKGROUNDVarious studies suggest that the insular cortex may play an underappreciated role in pediatric frontotemporal/parietal epilepsy. Here, we report on the postsurgical outcomes in 26 pediatric patients with confirmed insular involvement by depth electrode monitoring.OBJECTIVETo describe one of the largest series of pediatric patients with medically refractory epilepsy undergoing laser interstitial thermal therapy (LITT) or surgical resection of at least some portion of the insular cortex.METHODSPediatric patients in whom invasive insular sampling confirmed insular involvement and who subsequently underwent a second stage surgery (LITT or open resection) were included. Complications and Engel Class outcomes at least 1 yr postsurgery were compiled as well as pathology results in the open surgical cases.RESULTSThe average age in our cohort was 10.3 yr, 58% were male, and the average length of follow-up was 2.43 ± 0.20 (SEM) yr. A total of 14 patients underwent LITT, whereas 12 patients underwent open resection. Complications in patients undergoing either LITT or open resection were mostly minimal and generally transient. Forty-three percent of patients who underwent LITT were Engel Class I, compared to 50% of patients who underwent open insular resection.CONCLUSIONBoth surgical resection and LITT are valid management options in the treatment of medically refractory insular/opercular epilepsy in children. Although LITT may be a less invasive alternative to craniotomy, further studies are needed to determine its noninferiority in terms of complication rates and seizure freedom, especially in cases of cortical dysplasia that may involve extensive regions of the brain.

scholarly journals Retrospective analysis of open surgical versus laser interstitial thermal therapy callosotomy in pediatric patients with refractory epilepsy

2021 ◽  
pp. 1-9
Author(s):  
James P. Caruso ◽  
M. Burhan Janjua ◽  
Alison Dolce ◽  
Angela V. Price
Keyword(s):  
Blood Loss ◽  
Retrospective Analysis ◽  
Pediatric Patients ◽  
Refractory Epilepsy ◽  
Thermal Therapy ◽  
Efficacy And Safety ◽  
Corpus Callosotomy ◽  
Laser Interstitial Thermal Therapy ◽  
Medically Refractory Epilepsy

OBJECTIVECorpus callosotomy remains an established surgical treatment for certain types of medically refractory epilepsy in pediatric patients. While the traditional surgical approach is often well tolerated, the advent of MR-guided laser interstitial thermal therapy (LITT) provides a new opportunity to ablate the callosal body in a minimally invasive fashion and minimize the risks associated with an open interhemispheric approach. However, the literature is sparse regarding the comparative efficacy and safety profiles of open corpus callosotomy (OCC) and LITT callosotomy. To this end, the authors present a novel retrospective analysis comparing the efficacy and safety of these methods.METHODSPatients who underwent OCC and LITT callosotomy during the period from 2005 to 2018 were included in a single-center retrospective analysis. Patient demographic and procedural variables were collected, including length of stay, procedural blood loss, corticosteroid requirements, postsurgical complications, and postoperative disposition. Pre- and postoperative seizure frequency (according to seizure type) were recorded.RESULTSIn total, 19 patients, who underwent 24 interventions (16 OCC and 8 LITT), were included in the analysis. The mean follow-up durations for the OCC and LITT cohorts were 83.5 months and 12.3 months, respectively. Both groups experienced reduced frequencies of seizure and drop attack frequency postoperatively. Additionally, LITT callosotomy was associated with a significant decrease in estimated blood loss and decreased length of pediatric ICU stay, with a trend of shorter length of hospitalization.CONCLUSIONSLonger-term follow-up and a larger population are required to further delineate the comparative efficacies of LITT callosotomy and OCC for the treatment of pediatric medically refractory epilepsy. However, the authors’ data demonstrate that LITT shows promise as a safe and effective alternative to OCC.

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