Laser interstitial thermal therapy in treatment of brain tumors – the NeuroBlate System

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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Laser Interstitial Thermal Therapy in the Treatment of Thalamic Brain Tumors: A Case Series

Operative Neurosurgery ◽

10.1093/ons/opaa206 ◽

2020 ◽

Author(s):

Roger Murayi ◽

Hamid Borghei-Razavi ◽

Gene H Barnett ◽

Alireza M Mohammadi

Keyword(s):

Brain Tumors ◽

Thermal Damage ◽

Case Series ◽

Outcome Data ◽

Thermal Therapy ◽

Treatment Modalities ◽

Intracerebral Hematoma ◽

Average Hospital ◽

Laser Interstitial Thermal Therapy ◽

Thalamic Tumors

Abstract BACKGROUND Surgical options for patients with thalamic brain tumors are limited. Traditional surgical resection is associated with a high degree of morbidity and mortality. Laser interstitial thermal therapy (LITT) utilizes a stereotactically placed laser probe to induce thermal damage to tumor tissue. LITT provides a surgical cytoreduction option for this challenging patient population. We present our experience treating thalamic brain tumors with LITT. OBJECTIVE To describe our experience and outcomes using LITT on patients with thalamic tumors. METHODS We analyzed 13 consecutive patients treated with LITT for thalamic tumors from 2012 to 2017. Radiographic, clinical characteristics, and outcome data were collected via review of electronic medical records RESULTS Thirteen patients with thalamic tumors were treated with LITT. Most had high-grade gliomas, including glioblastoma (n = 9) and anaplastic astrocytoma (n = 2). The average tumor volume was 12.0 cc and shrank by 42.9% at 3 mo. The average hospital stay was 3.0 d. Median ablation coverage as calculated by thermal damage threshold (TDT) lines was 98% and 95% for yellow (>43°C for >2 min) or blue (>10 min), respectively. Median disease-specific progression-free survival calculated for 8 patients in our cohort was 6.1 mo (range: 1.1-15.1 mo). There were 6 patients with perioperative morbidity and 2 perioperative deaths because of intracerebral hematoma. CONCLUSION LITT is a feasible treatment for patients with thalamic tumors. LITT offers a cytoreduction option in this challenging population. Patient selection is key. Close attention should be paid to lesion size to minimize morbidity. More studies comparing treatment modalities of thalamic tumors need to be performed.

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A Curved Port Delivery System for Laser Interstitial Thermal Therapy of Brain Tumors

2019 Design of Medical Devices Conference ◽

10.1115/dmd2019-3305 ◽

2019 ◽

Author(s):

Nnaoma Agwu ◽

Kyle Deprow ◽

John E. Williams ◽

Jenna L. Gorlewicz ◽

Eric C. Leuthardt

Keyword(s):

Heat Treatment ◽

Brain Tumors ◽

Delivery System ◽

Thermal Therapy ◽

Neurosurgical Procedure ◽

Surgical Tools ◽

Laser Interstitial Thermal Therapy ◽

Steerable Needles ◽

The Brain ◽

Straight Trajectory

Laser interstitial thermal therapy (LITT) is a neurosurgical procedure that involves using heat treatment to ablate glioblastomas in the brain. Current methods for placing probes in LITT involve straight trajectory pathways. This limitation often requires surgeons to make multiple trajectories or leave undesired margins. There has been extensive work in steerable needles, concentric tube cannulas, and flexible surgical tools. In this work, we present an approach which focuses on providing steerability to tools that aren’t inherently steerable. To do this, we developed a curved port delivery system that leverages an active cannula for the deployment of a plastic, flexible port that delivers existing surgical tools. We present an initial prototype coupled with feasibility results illustrating that the port can be placed to steer probes to a desired location.

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Laser interstitial thermal therapy

Neuro-Oncology Advances ◽

10.1093/noajnl/vdz035 ◽

2019 ◽

Vol 2 (1) ◽

Author(s):

Katherine G Holste ◽

Daniel A Orringer

Keyword(s):

Brain Tumors ◽

Brain Metastases ◽

Small Sample ◽

Brain Lesions ◽

Thermal Therapy ◽

Open Approach ◽

Primary Brain Tumors ◽

Laser Interstitial Thermal Therapy ◽

Frontline Treatment ◽

Small Sample Sizes

Abstract Background Laser interstitial thermal therapy (LITT) is becoming an increasingly popular technique for the treatment of brain lesions. More minimally invasive that open craniotomy for lesion resection, LITT may be more appropriate for lesions that are harder to access through an open approach, deeper lesions, and for patients who may not tolerate open surgery. Methods A search of the current primary literature on LITT for brain lesions on PubMed was performed. These studies were reviewed and updates on the radiological, pathological, and long-term outcomes after LITT for brain metastases, primary brain tumors, and radiation necrosis as well as common complications are included. Results Larger extent of ablation and LITT as frontline treatment were potential predictors of favorable progression-free and overall survival for primary brain tumors. In brain metastases, larger extent of ablation was more significantly associated with survival benefit, whereas tumor size was a possible predictor. The most common complications after LITT are transient and permanent weakness, cerebral edema, hemorrhage, seizures, and hyponatremia. Conclusions Although the current literature is limited by small sample sizes and primarily retrospective studies, LITT is a safe and effective treatment for brain lesions in the correct patient population.

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Laser interstitial thermal therapy in neuro-oncology applications

Surgical Neurology International ◽

10.25259/sni_496_2019 ◽

2020 ◽

Vol 11 ◽

pp. 231

Author(s):

Christopher S. Hong ◽

Adam J. Kundishora ◽

Aladine A. Elsamadicy ◽

Veronica L. Chiang

Keyword(s):

Brain Tumors ◽

De Novo ◽

English Literature ◽

Relevant Literature ◽

Cost Benefit ◽

Standard Of Care ◽

Thermal Therapy ◽

Laser Interstitial Thermal Therapy ◽

Advantages And Disadvantages ◽

Pubmed Database

Background: Laser interstitial thermal therapy (LITT) is a minimally invasive surgical treatment for multiple intracranial pathologies that are of growing interest to neurosurgeons and their patients and is emerging as an effective alternative to standard of care open surgery in the neurosurgical armamentarium. This option was initially considered for those patients with medical comorbidities and lesion-specific characteristics that confer excessively high risk for resection through a standard craniotomy approach but indications are changing. Methods: The PubMed database was searched for studies in the English literature on LITT for the treatment of primary and metastatic brain tumors, meningiomas, as well as for radiation necrosis (RN) in previously irradiated brain tumors. Results: This review provides an update of the relevant literature regarding application of LITT in neurosurgical oncology for the treatment of de novo and recurrent primary gliomas and brain metastases radiographically regrowing after previous irradiation as recurrent tumor or RN. In addition, this review details the limited experience of LITT with meningiomas and symptomatic peritumoral edema after radiosurgery. The advantages and disadvantages, indications, and comparisons to standard of care treatments such as craniotomy for open surgical resection are discussed for each pathology. Finally, the literature on cost-benefit analyses for LITT are reviewed. Conclusion: The studies discussed in this review have helped define the role of LITT in neurosurgical oncology and delineate optimal patient selection and tumor characteristics most suitable to this intervention.

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EMBR-18. LASER INTERSTITIAL THERMAL THERAPY FOR RECURRENT MEDULLOBLASTOMA

Neuro-Oncology ◽

10.1093/neuonc/noab090.036 ◽

2021 ◽

Vol 23 (Supplement_1) ◽

pp. i9-i9

Author(s):

Jordan Xu ◽

Jodi Pathare ◽

Clay Hoerig ◽

Aaron Goldberg ◽

Chenue Abongwa ◽

...

Keyword(s):

Brain Tumors ◽

Invasive Procedure ◽

Poor Quality ◽

Thermal Therapy ◽

Recurrent Tumor ◽

Invasive Approach ◽

Laser Interstitial Thermal Therapy ◽

Initial Surgery ◽

Surveillance Imaging ◽

Increased Risk

Abstract Background Medulloblastoma is one of the most common malignant childhood brain tumors and is managed by maximal surgical resection followed by cranio-spinal irradiation and adjuvant chemotherapy. The estimates for survival have not significantly improved over the last two decades, and survivors have an increased risk of poor quality of life. Disease relapse occurs in around 30% of children and survival is less than 20%. Laser interstitial thermal therapy (LITT) is a minimally invasive approach that has been increasingly used to treat brain lesions, particularly for high-risk surgeries. While LITT has been described in a variety of primary brain tumors, including glioblastoma multiforme and metastatic brain tumors, there have been few reports of LITT for recurrent medulloblastoma. Case Description We describe a case of an 11-year-old female with recurrent medulloblastoma first treated at age 5. She initially underwent gross total resection complicated by severe posterior fossa syndrome followed by chemotherapy and radiation (per ACNS0332). She was unfortunately found to have a new enhancing lesion on surveillance imaging 6 years later, and a biopsy confirmed recurrent tumor. Due to morbidity from initial surgery, the family did not wish to pursue further open resection but agreed to proceed with laser ablation as an alternative. She continues on Avastin/irinotecan/TMZ. Surveillance MRI nearly a year later shows a significant reduction in tumor size and enhancement. Conclusion Recurrent medulloblastoma is a highly aggressive tumor that conveys a poor prognosis. LITT offers a less invasive procedure that may serve as an adjunct in treating recurrent tumor or as palliation. Longer term follow-up and additional cases will help understand the efficacy of LITT in recurrent medulloblastoma.

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