scholarly journals Stereotactic Laser Ablation (SLA) Followed by Consolidation Stereotactic Radiosurgery (cSRS) as Treatment for Brain Metastasis that Recurred Locally After Initial Radiosurgery (BMRS): A Multi-Institutional Experience

2021 ◽  
Author(s):  
Isabela Peña Pino ◽  
Jun Ma ◽  
Yusuke Hori ◽  
Elena Fomchenko ◽  
Kathryn Dusenbery ◽  
...  
Keyword(s):  
Laser Ablation ◽  
Brain Metastasis ◽  
Local Control Rate ◽  
Neurological Deficits ◽  
Wound Complications ◽  
Karnofsky Performance Score ◽  
Treatment Paradigm ◽  
Institutional Experience ◽  
Active Investigation

Abstract Introduction: The optimal treatment paradigm for brain metastasis that recurs locally after initial radiosurgery (BMRS) remains an area of active investigation. Here, we report outcomes for patients with BMRS treated with stereotactic laser ablation (SLA, also known as laser interstitial thermal therapy, LITT)followed by consolidation radiosurgery (cSRS). Methods: Clinical outcome of 20 patients with 21histologically confirmed BMRS treated with SLA followed by consolidation SRS and >6 months follow-up were collected retrospectively across three participating institutions. Results: Consolidation SRS (5 Gy x 5 or 6 Gy x 5) wascarried out 16-73 days (median of 26 days) post-SLA of BMRS. There were no new neurological deficits after SLA/cSRS. While 3/21 (14.3%) patients suffered temporary Karnofsky Performance Score (KPS) decline after SLA, no KPS declines was observed after cSRS. There were no 30-day mortalities or wound complications. Two patients required re-admission within 30 days of cSRS (severe headache that resolved with steroid therapy (n=1) and new onset seizure (n=1)). With a median follow-up of 228 days (range: 178-1367 days), the local control rate at 6 and 12 months (LC6, LC12) was 100%. All showed diminished FLAIR volume surrounding the SLA/cSRS treated BMRS at the six-month follow-up; none of the patients required steroid for symptoms attributable to these BMRS. These results compare favorably to the available literature for repeat SRS or SLA-only treatment of BMRS.Conclusions: This multi-institutional experience supports further investigations of SLA/cSRS as a treatment strategyfor BMRS.

RADT-04. STEREOTACTIC LASER ABLATION (SLA) FOLLOWED BY CONSOLIDATION STEREOTACTIC RADIOSURGERY (SRS) AS A TREATMENT STRATEGY FOR BRAIN METASTASIS THAT RECURRED LOCALLY AFTER INITIAL RADIOSURGERY (BMRS)

2021 ◽  
Vol 23 (Supplement_6) ◽  
pp. vi41-vi41
Author(s):  
Isabela Pena-Pino ◽  
Jun Ma ◽  
Yusuki Hori ◽  
Elena Fomchenko ◽  
Kathryn Dusenbery ◽  
...  
Keyword(s):  
Laser Ablation ◽  
Steroid Therapy ◽  
Local Control ◽  
Treatment Strategy ◽  
Median Overall Survival ◽  
Systemic Disease ◽  
Wound Complications ◽  
Institutional Experience ◽  
New Onset

Abstract INTRODUCTION In independent clinical trials, ~30% of brain metastases recur locally after radiosurgery (BMRS). For these lesions, treatment with stereotactic laser ablation (SLA, also known as laser interstitial thermal therapy (LITT)) alone achieves a 12-month local control (LC12) of 54-85% while repeat SRS achieved LC12 of 54-79%. Here, we report favorable outcomes for BMRS treated with SLA followed by consolidation radiosurgery (SLA/cSRS). METHODS Clinical outcome of 18 patients with 19 histologically confirmed BMRS treated with SLA followed by consolidation SRS and >3 months follow-up were collected retrospectively across three institutions. Local control was defined as stability or decrease in contrast-enhancing (CE) and FLAIR volume. RESULTS SLA achieved ablation of 73-100% of the BMRS CE volumes. Consolidation hypo-fractionated radiosurgery (5 Gy x 5 or 6 Gy x 5) was carried out 16-40 days post-SLA (median of 26 days). With a median follow-up of 185 days (range: 93-1367 days) and median overall survival (OS) of 185 days (range: 99-1367 days), 100% LC12 was achieved. 13/18 (72%) patients that required steroid therapy prior to SLA/cSRS were successfully weaned off steroid by three months post-SLA/cSRS. Post-SLA, KPS declined for 3/19 (16%) patients and improved for 1/19 (5%) patients. No KPS changes occurred subsequent to consolidation SRS. There were no 30-day mortalities or wound complications. Two patients required re-admission within 30 days of SRS (severe headache that resolved with steroid therapy (n=1) and new-onset seizure (n=1)). Except for two patients who suffered histologically confirmed, local failure at 649 and 899 days, all other patients are either alive (n=6) or died from systemic disease progression (n=10). None of the treated patients developed symptomatic radiation necrosis. CONCLUSIONS This collaborative institutional experience support efficacy and safety of SLA followed by consolidation SRS as a treatment for BMRS. The treatment strategy warrants further investigations.

scholarly journals SURG-02. Stereotactic Laser Ablation (SLA) followed by consolidation stereotactic radiosurgery (SRS) as a treatment strategy for brain metastasis that recurred locally after initial radiosurgery (BMRS): a collaborative institutional experience

2021 ◽  
Vol 3 (Supplement_3) ◽  
pp. iii23-iii23
Author(s):  
Isabela Pena-Pino ◽  
Jun Ma ◽  
Yusuki Hori ◽  
Elena Fomchenko ◽  
Kathryn Dusenbery ◽  
...  
Keyword(s):  
Laser Ablation ◽  
Steroid Therapy ◽  
Local Control ◽  
Treatment Strategy ◽  
Median Overall Survival ◽  
Systemic Disease ◽  
Wound Complications ◽  
Institutional Experience ◽  
New Onset

Abstract Introduction In independent clinical trials, ~30% of brain metastases recur locally after radiosurgery (BMRS). For these lesions, treatment with stereotactic laser ablation (SLA, also known as laser interstitial thermal therapy (LITT)) alone achieves a 12-month local control (LC12) of 54–85% while repeat SRS achieved LC12 of 54–79%. Here, we report favorable outcomes for BMRS treated with SLA followed by consolidation radiosurgery (SLA/cSRS). Methods Clinical outcome of 18 patients with 19 histologically confirmed BMRS treated with SLA followed by consolidation SRS and >3 months follow-up were collected retrospectively across three institutions. Local control was defined as stability or decrease in contrast-enhancing (CE) and FLAIR volume. Results SLA achieved ablation of 73–100% of the BMRS CE volumes. Consolidation hypo-fractionated radiosurgery (5 Gy x 5 or 6 Gy x 5) was carried out 16–40 days post-SLA (median of 26 days). With a median follow-up of 185 days (range: 93–1367 days) and median overall survival (OS) of 185 days (range: 99–1367 days), 100% LC12 was achieved. 13/18 (72%) patients that required steroid therapy prior to SLA/cSRS were successfully weaned off steroid by three months post-SLA/cSRS. Post-SLA, KPS declined for 3/19 (16%) patients and improved for 1/19 (5%) patients. No KPS changes occurred subsequent to consolidation SRS. There were no 30-day mortalities or wound complications. Two patients required re-admission within 30 days of SRS (severe headache that resolved with steroid therapy (n=1) and new-onset seizure (n=1)). Except for two patients who suffered histologically confirmed, local failure at 649 and 899 days, all other patients are either alive (n=5) or died from systemic disease progression (n=11). None of the treated patients developed symptomatic radiation necrosis. Conclusions This collaborative institutional experience support efficacy and safety of SLA followed by consolidation SRS as a treatment for BMRS. The treatment strategy warrants further investigations.

scholarly journals MRI-Guided Stereotactic Laser Ablation of Deep-Seated Cerebral Cavernous Malformations

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
James A M Douglas ◽  
Alex C M Greven ◽  
Christopher W Rich ◽  
James G Malcolm ◽  
Robert E Gross ◽  
...  
Keyword(s):  
Laser Ablation ◽  
Brain Structures ◽  
Neurological Symptoms ◽  
Neurological Deficits ◽  
Recurrent Bleeding ◽  
Cerebral Cavernous Malformations ◽  
Cavernous Malformations ◽  
Mri Guided ◽  
Deep Brain

Abstract INTRODUCTION Magnetic resonance imaging (MRI)-guided stereotactic laser ablation (SLA) is a minimally invasive alternative to open surgery for symptomatic cerebral cavernous malformations (CCMs). While SLA of neocortical and medial temporal lesions is described, we examined the safety and effectiveness of SLA of deep-seated symptomatic CCMs in patients considered to be poor candidates for open resection. METHODS We analyzed 4 patients who presented with neurological symptoms associated with a CCM in deep brain structures. Each patient underwent CCM SLA with an effort to exclude adjacent brain parenchyma followed by standard clinical and imaging follow-up. RESULTS Three patients presented with chronic medically refractory headache and small lesions (0.1-2.6 cm3) consistent with CCM in thalamus (2) or putamen (1). A fourth patient presented with recurrent bleeding and hemiparesis associated with a large CCM (4.3 cm3) of the subthalamus/midbrain. Symptoms durations were 0.5 to 7 yr. SLA was performed using Visualase (Medtronic, Inc.); perilesional brain was monitored to avoid thermal injury. Out of 4 patients, all demonstrated a decrease in CCM volume and improvement of neurological symptoms at 5 to 23 mo follow-up. Two patients (one thalamus, one putamen), experienced evidence of hemorrhage during ablation (apparent with intraoperative MRI), limiting the extent of ablation in one case. Both patients were stabilized and made full recoveries. The ablation in subthalamus/midbrain was not associated with bleeding but did exacerbate hemiparesis, requiring rehabilitation. Hospital stays ranged from 2 to 5 d. CONCLUSION In a retrospective series, MR thermography guided SLA of symptomatic deep brain CCM was technically feasible. Unlike a prior series of more superficial epileptogenic CCM in which no hemorrhages were observed, SLA of deep CCM may carry higher risk of bleeding and neurological deficits. Larger, longer-term studies are required.

scholarly journals Magnetic resonance–guided stereotactic laser ablation therapy for the treatment of pediatric brain tumors: a multiinstitutional retrospective study

2020 ◽  
Vol 26 (1) ◽  
pp. 13-21
Author(s):  
Elsa V. Arocho-Quinones ◽  
Sean M. Lew ◽  
Michael H. Handler ◽  
Zulma Tovar-Spinoza ◽  
Matthew Smyth ◽  
...  
Keyword(s):  
Laser Ablation ◽  
Brain Tumors ◽  
Adjuvant Treatment ◽  
Pediatric Brain Tumors ◽  
Tumor Location ◽  
Neurological Deficits ◽  
Low Grade ◽  
High Grade ◽  
Pediatric Brain

OBJECTIVEThis study aimed to assess the safety and efficacy of MR-guided stereotactic laser ablation (SLA) therapy in the treatment of pediatric brain tumors.METHODSData from 17 North American centers were retrospectively reviewed. Clinical, technical, and radiographic data for pediatric patients treated with SLA for a diagnosis of brain tumor from 2008 to 2016 were collected and analyzed.RESULTSA total of 86 patients (mean age 12.2 ± 4.5 years) with 76 low-grade (I or II) and 10 high-grade (III or IV) tumors were included. Tumor location included lobar (38.4%), deep (45.3%), and cerebellar (16.3%) compartments. The mean follow-up time was 24 months (median 18 months, range 3–72 months). At the last follow-up, the volume of SLA-treated tumors had decreased in 80.6% of patients with follow-up data. Patients with high-grade tumors were more likely to have an unchanged or larger tumor size after SLA treatment than those with low-grade tumors (OR 7.49, p = 0.0364). Subsequent surgery and adjuvant treatment were not required after SLA treatment in 90.4% and 86.7% of patients, respectively. Patients with high-grade tumors were more likely to receive subsequent surgery (OR 2.25, p = 0.4957) and adjuvant treatment (OR 3.77, p = 0.1711) after SLA therapy, without reaching significance. A total of 29 acute complications in 23 patients were reported and included malpositioned catheters (n = 3), intracranial hemorrhages (n = 2), transient neurological deficits (n = 11), permanent neurological deficits (n = 5), symptomatic perilesional edema (n = 2), hydrocephalus (n = 4), and death (n = 2). On long-term follow-up, 3 patients were reported to have worsened neuropsychological test results. Pre-SLA tumor volume, tumor location, number of laser trajectories, and number of lesions created did not result in a significantly increased risk of complications; however, the odds of complications increased by 14% (OR 1.14, p = 0.0159) with every 1-cm3 increase in the volume of the lesion created.CONCLUSIONSSLA is an effective, minimally invasive treatment option for pediatric brain tumors, although it is not without risks. Limiting the volume of the generated thermal lesion may help decrease the incidence of complications.

scholarly journals Prognostic factors and outcomes in anaplastic gliomas: An institutional experience

2018 ◽  
Vol 07 (01) ◽  
pp. 01-04 ◽  
Author(s):  
Deepthi Valiyaveettil ◽  
Monica Malik ◽  
Deepa Joseph ◽  
Syed Fayaz Ahmed ◽  
Syed Akram Kothwal
Keyword(s):  
Adjuvant Chemotherapy ◽  
Treatment Guidelines ◽  
Standard Of Care ◽  
Adjuvant Radiation ◽  
Karnofsky Performance Score ◽  
Focal Neurological Deficit ◽  
Time To Recurrence ◽  
Anaplastic Gliomas ◽  
Institutional Experience

Abstract Background: There is lack of clear evidence and treatment guidelines for anaplastic gliomas (AGs) with very few studies focusing exclusively on these patients. The aim of the study was to analyze the clinical profile and survival in these patients. Materials and Methods: Patients of AGs treated with radiation and concurrent ± adjuvant chemotherapy from January 2010 to December 2015 were analyzed. Statistical analysis was done using SPSS version 20 software. Results: A total of 100 patients were included in the study. The median age was 35 years (range 6–68 years). Eighty-four patients had follow-up details and were included for survival analysis. The 5-year overall survival (OS) was 58%. Age, presentation with seizures, and focal neurological deficit were not found to significantly influence survival. The 5-year survival for oligodendroglioma and astrocytoma was 69% and 52%, respectively. Patients with Karnofsky Performance Score (KPS) of ≥70 had a significantly better 5-year OS (65%) as compared to those with KPS <70 (33%) (P = 0.000). The use of adjuvant temozolomide (TMZ) showed longer 5-year OS of 67.7% compared to 36% in patients who did not receive adjuvant chemotherapy (P = 0.018). Patients receiving both concurrent and adjuvant TMZ showed longer 5-year OS (68.5% vs. 40%, P = 0.010). Twenty-two patients had recurrence with average time to recurrence being 37 months. Fourteen patients underwent salvage surgery and two patients received reirradiation. Conclusions: OS significantly correlated with KPS and receipt of concurrent and adjuvant chemotherapy with TMZ. Therefore, adjuvant radiation with concurrent and adjuvant TMZ should be the standard of care for AGs.

Pilonidal sinus disease: Karydakis flap procedure in our patients

2020 ◽  
Vol 99 (8) ◽  
Keyword(s):  
Wound Healing ◽  
Pilonidal Sinus ◽  
Healing Process ◽  
Pilonidal Sinus Disease ◽  
Wound Complications ◽  
Limberg Flap ◽  
New Disease ◽  
Sinus Disease ◽  
Flap Procedure

Introduction: Despite the available guidelines, opinions of many surgeons are quite ambiguous when it comes to the therapy of pilonidal sinus disease. The treatment can be a frustrating problem both for the surgeon and the patient because it is associated with wound complications and high recurrence rate. The objective of this study was to analyze the results of patients with pilonidal sinus disease undergoing the Karydakis flap procedure. Methods: A total of 27 patients treated for primary and recurrent pilonidal disease using the Karydakis flap procedure at our department between October 23, 2018 and November 22, 2019 were analyzed prospectively. We evaluated postoperative wound healing, complications and recurrence of the disease in a short-term follow-up period. Disease recurrence was defined as prolonged healing or as a new disease requiring repeated surgery. Results: In December 2019 all 27 patients came for a follow-up visit. The result was a fully lateralized wound without any signs of a new disease in all patients. In May 2020 a follow-up visit by phone was performed. The median follow-up was 12 months. The healing process was free of any serious complications in 25 patients. Seroma formation cases were managed by puncture in the outpatient setting. Conclusion: According to the available evidence and guidelines, off-midline procedures – the Karydakis flap, Bascom cleft lift, and Limberg flap procedures – are associated with lower recurrence rates and better wound healing. An important goal is to achieve complete wound lateralization and to change the configuration of the gluteal cleft by reshaping it, which results in a nicely flattened gluteal crease.

Microsurgical resection of medullary cavernoma via the olivary zone by the retrosigmoid supracondylar approach

2019 ◽  
Vol 1 (2) ◽  
pp. V7
Author(s):  
Ken Matsushima ◽  
Michihiro Kohno ◽  
Helmut Bertalanffy
Keyword(s):  
Cavernous Malformation ◽  
Cleavage Plane ◽  
Foramen Magnum ◽  
Senior Author ◽  
Neurological Deficits ◽  
Lateral Part ◽  
Sitting Position ◽  
Brainstem Cavernoma ◽  
Microsurgical Resection

Microsurgical resection of the medullary cavernoma is rare, comprising less than 15% of more than 250 surgeries of brainstem cavernoma performed by the senior author (H.B.).1 This video demonstrates a case of a cavernous malformation inside the lateral part of the medulla, which was surgically treated via the olivary zone by the retrosigmoid supracondylar approach in a half-sitting position. Osseous drilling of the lateral foramen magnum provided wide exposure of the cerebellomedullary cistern around the olive.2,3 The lesion was completely dissected at the appropriate cleavage plane from the normal parenchyma. The patient developed no new neurological deficits and had no recurrence during 3 years of follow-up after the operation.The video can be found here: https://youtu.be/7i7SccS5HmU.

Management and outcomes of isolated interhemispheric subdural hematomas associated with falx syndrome

2019 ◽  
Vol 131 (6) ◽  
pp. 1920-1925
Author(s):  
Daniel A. Tonetti ◽  
William J. Ares ◽  
David O. Okonkwo ◽  
Paul A. Gardner
Keyword(s):  
Neurological Deterioration ◽  
Neurological Deficits ◽  
Motor Deficits ◽  
Study Cohort ◽  
Venous Infarction ◽  
Nonsurgical Management ◽  
Subdural Hematomas ◽  
Poor Outcomes ◽  
Contemporary Management

OBJECTIVELarge interhemispheric subdural hematomas (iSDHs) causing falx syndrome are rare; therefore, a paucity of data exists regarding the outcomes of contemporary management of iSDH. There is a general consensus among neurosurgeons that large iSDHs with neurological deficits represent a particular treatment challenge with generally poor outcomes. Thus, radiological and clinical outcomes of surgical and nonsurgical management for iSDH bear further study, which is the aim of this report.METHODSA prospectively collected, single-institution trauma database was searched for patients with isolated traumatic iSDH causing falx syndrome in the period from January 2008 to January 2018. Information on demographic and radiological characteristics, serial neurological examinations, clinical and radiological outcomes, and posttreatment complications was collected and tallied. The authors subsequently dichotomized patients by management strategy to evaluate clinical outcome and 30-day survival.RESULTSTwenty-five patients (0.4% of those with intracranial injuries, 0.05% of those with trauma) with iSDH and falx syndrome represented the study cohort. The average age was 73.4 years, and most patients (23 [92%] of 25) were taking anticoagulants or antiplatelet medications. Six patients were managed nonoperatively, and 19 patients underwent craniotomy for iSDH evacuation; of the latter patients, 17 (89.5%) had improvement in or resolution of motor deficits postoperatively. There were no instances of venous infarction, reaccumulation, or infection after evacuation. In total, 9 (36%) of the 25 patients died within 30 days, including 6 (32%) of the 19 who had undergone craniotomy and 3 (50%) of the 6 who had been managed nonoperatively. Patients who died within 30 days were significantly more likely to experience in-hospital neurological deterioration prior to surgery (83% vs 15%, p = 0.0095) and to be comatose prior to surgery (100% vs 23%, p = 0.0031). The median modified Rankin Scale score of surgical patients who survived hospitalization (13 patients) was 1 at a mean follow-up of 22.1 months.CONCLUSIONSiSDHs associated with falx syndrome can be evacuated safely and effectively, and prompt surgical evacuation prior to neurological deterioration can improve outcomes. In this study, craniotomy for iSDH evacuation proved to be a low-risk strategy that was associated with generally good outcomes, though appropriately selected patients may fare well without evacuation.

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