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.

Phase I study of PD-L1 inhibition with avelumab and laser interstitial thermal therapy in patients with recurrent glioblastoma.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. TPS2074-TPS2074 ◽  
Author(s):  
Adilia Hormigo ◽  
John Mandeli ◽  
Constantinos Hadjipanayis ◽  
Sacha Gnjatic ◽  
Seunghee Kim-Schulze ◽  
...  
Keyword(s):  
Treatment Options ◽  
Recurrent Glioblastoma ◽  
Thermal Therapy ◽  
Successful Implementation ◽  
Open Label ◽  
Stage Design ◽  
Laser Interstitial Thermal Therapy ◽  
Dismal Prognosis ◽  
Mri Guided ◽  
Clinical Trial Information

TPS2074 Background: Glioblastoma (GBM) the most frequent malignant brain tumor in the adult has a dismal prognosis and limited treatment options. Current advances have highlighted how tumors and specifically GBM evade the immune system by exploiting the mechanisms of tolerance and inducing local and systemic immunosuppression. Another hurdle in the treatment of GBM is the blood-brain barrier (BBB). Recent work suggests that MRI-guided laser interstitial thermal therapy (LITT) can increase the permeability of the BBB and may have an abscopal effect. Therefore, utilizing MRI-guided LITT, a potential immunogenic cell death-inducing procedure that disrupts the BBB and makes Avelumab a PD-L1 monoclonal antibody being more accessible to GBM tumors, seem a valid approach for immunomodulation and successful implementation of a combined regimen to treat brain cancer. Methods: This is a prospective non-randomized open label to characterize the tolerability and safety profile of Avelumab in combination with LITT in patients with recurrent glioblastoma who were treated with radiation therapy with concurrent Temozolomide chemotherapy at diagnosis, and whose tumor at recurrence measures less then 3 cm3. Avelumab is administered within a week after real-time MRI-guided LITT therapy and every 2 weeks thereafter. On part A patients are treated with intravenous Avelumab alone and on part B patients receive Avelumab in combination with MRI-guided LITT. Part A completed enrollment without DLT. Enrollment on part B began in October 2018. A Simon minimax two-stage design is being used for efficacy. Toxicity will be scored using the NCI-CTCAE 4.03 criteria. Blood samples and tumor tissue will be collected for correlative studies. Quantification of the changes in inflammatory and immunosuppressive profiles across time points for patients receiving treatment with Avelumab will be obtained. This information will instruct future immunotherapy approaches to treat GBM and the rational for those combinations. Clinical trial information: NCT03341806.

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.

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.

MRI-Guided Laser Interstitial Thermal Therapy in Neuro-Oncology: A Review of Its Current Clinical Applications

Oncology ◽  
2014 ◽  
Vol 87 (2) ◽  
pp. 67-82 ◽  
Author(s):  
Gazanfar Rahmathulla ◽  
Pablo F. Recinos ◽  
Kambiz Kamian ◽  
Alireza M. Mohammadi ◽  
Manmeet S. Ahluwalia ◽  
...  
Keyword(s):  
Clinical Applications ◽  
Thermal Therapy ◽  
Laser Interstitial Thermal Therapy ◽  
Mri Guided

Influence of Stent Configuration on Cerebral Aneurysm Fluid Dynamics

2010 ◽  
Author(s):  
Haithem Babiker ◽  
L. Fernando Gonzalez ◽  
Felipe Albuquerque ◽  
Daniel Collins ◽  
Arius Elvikis ◽  
...  
Keyword(s):  
Fluid Dynamics ◽  
Treatment Option ◽  
Treatment Options ◽  
Cerebral Aneurysms ◽  
Endovascular Coiling ◽  
Invasive Technique ◽  
Surgical Clipping ◽  
The Past ◽  
Alternative Treatment Option ◽  
Wide Neck

Treatment options for cerebral aneurysms have drastically evolved in the last decade. In the past, surgical clipping through craniotomy was the predominant treatment option for cerebral aneurysms. Presently, endovascular coiling, a minimally invasive technique, has superseded clipping in many centers [1]. However, the coiling of wide-neck aneurysms is still a challenge [2]. Complete aneurysmal occlusion is often impossible [3]. Recently, stand-alone stents have been explored as an alternative treatment option for wide-neck aneurysms [4].

scholarly journals SURG-07. Plasmonic gold nanostars to increase the efficiency and specificity of laser interstitial thermal therapy (LITT) in the treatment of brain tumors

2021 ◽  
Vol 3 (Supplement_3) ◽  
pp. iii24-iii25
Author(s):  
Ethan Srinivasan ◽  
Pakawat Chongsathidkiet ◽  
Ren Odion ◽  
Yang Liu ◽  
Eric Sankey ◽  
...  
Keyword(s):  
Ex Vivo ◽  
Thermal Therapy ◽  
Surrounding Tissue ◽  
Intracranial Tumors ◽  
Invasive Treatment ◽  
Laser Interstitial Thermal Therapy ◽  
Gold Nanostars ◽  
Pet Ct ◽  
The Impact

Abstract Introduction Laser interstitial thermal therapy (LITT) is an effective minimally-invasive treatment option for intracranial tumors. Our group produced plasmonics-active gold nanostars (GNS) designed to preferentially accumulate within intracranial tumors and amplify the ablative capacity of LITT while better conforming to tumor boundaries and protecting surrounding tissue. Materials and Methods: The 12nm GNS were synthesized using reduced HAuCl4 with Na3C6H5O7 seeds, mixed with AgNO3, C6H8O6, and HAuCL4, and coated with polyethylene glycol then functionalized with methoxy PEG thiol. CT-2A glioma cells were intracranially implanted into mice, followed 18 days later by IV injection of GNS. PET-CT was performed at 10-minutes, 24-, and 72-hours post-GNS administration, with autoradiography (AR) and histopathology (HP) on sacrifice after the last scan. To test the impact of GNS on LITT coverage capacity in appropriately sized ex vivo models, we utilized agarose gel-based phantoms incorporating control and GNS-infused central “tumors” in multiple shapes. LITT was administered with the NeuroBlate System. Results In vivo, GNS preferentially accumulated within intracranial tumors on PET-CT at the 24- and 72-hour timepoints. AR and HP confirmed high GNS accumulation within tumor. Ex vivo, in cuboid tumor phantoms, the GNS-infused phantom heated 5.5x faster than the control, rising 0.49°C per minute compared to 0.09°C. In a split-cylinder tumor phantom with half containing GNS, the GNS-infused border heated 2x faster and the surrounding area was exposed to 30% lower temperatures. In a GNS-infused star-shaped phantom, the heat spread contoured along phantom boundaries. Conclusion Our results provide evidence for use of GNS to improve the specificity, efficiency, and potentially safety of LITT. The in vivo data support selective accumulation within intracranial tumors, and the GNS-infused phantom experiments demonstrate increased rates of heating within the tumor model, heat contouring to tumor borders, and decreased heating of surrounding regions representing normal structures.

SURG-03. FUNCTIONAL OUTCOMES OF LASER INTERSTITIAL THERMAL THERAPY (LITT) VERSUS RESECTION IN THE TREATMENT OF LESIONS IN OR NEAR THE PRIMARY MOTOR CORTEX

2021 ◽  
Vol 23 (Supplement_6) ◽  
pp. vi195-vi195
Author(s):  
Ethan Srinivasan ◽  
Emily Lerner ◽  
Ryan Edwards ◽  
David Huie ◽  
Peter Fecci
Keyword(s):  
Motor Cortex ◽  
Functional Outcomes ◽  
Primary Motor Cortex ◽  
Thermal Therapy ◽  
Invasive Treatment ◽  
Motor Mapping ◽  
Laser Interstitial Thermal Therapy ◽  
Hospital Stays ◽  
The Difference ◽  
Pre Treatment

Abstract INTRODUCTION Laser interstitial thermal therapy (LITT) is a minimally-invasive treatment option for radiographically-progressive (RP) brain metastases. This study compares the functional outcomes of LITT vs resection (RS) for lesions in or near the primary motor cortex (PMC). METHODS Retrospective review was performed of patients treated for PMC lesions by LITT or RS. Functional outcomes were graded relative to pre-treatment symptoms and categorized as improved, stable, or worsened at 30, 90, and 180 days post-LITT/RS. RESULTS 36 patients were identified with median follow-up of 194 days (IQR 72-503), age 64 years (57-72), and estimated baseline KPS 80 (80-90). 35 (98%) had pre-treatment weakness or motor seizure; 15 (42%) received LITT and 21 (58%) RS; all RS were performed with intra-operative motor mapping while LITT were not. All LITT patients were treated for RP lesions (radiation necrosis (RN) or disease progression) vs. 24% of RS patients (p< 0.01). LITT patients trended towards smaller lesions (1.9 cm vs 2.7 cm, p=0.03) and were more likely to show RN (67% vs 5%, p< 0.01) and be discharged home (87% vs 52%, p=0.04), with shorter ICU (0 vs 1 day, p< 0.01) and hospital stays (1 vs. 2 days, p< 0.01). At 30 days, 89% of surviving patients who received RS had stable or improved symptoms, compared to 46% of the LITT cohort (p=0.02). At 90 days, the difference was 88% to 50% (p=0.07), and at 180 days 100% to 80% (p=0.2941). CONCLUSIONS In the short term (30 days), patients with PMC lesions have better functional outcomes when treated with RS compared to LITT, while those who survive to the 180-day timepoint experience similar outcomes. These differences are likely due to transient, expected post-LITT edema that subsides with time. Taken together, prognosis and patient priorities are important considerations in the decision between LITT and RS.

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