scholarly journals Laser interstitial thermal therapy for palliative ablation of a chordoma metastasis to the spine: case report

2017 ◽  
Vol 26 (6) ◽  
pp. 722-724 ◽  
Author(s):  
Brian J. Williams ◽  
Patrick J. Karas ◽  
Ganesh Rao ◽  
Laurence D. Rhines ◽  
Claudio E. Tatsui
Keyword(s):  
Spinous Process ◽  
Thermal Therapy ◽  
Upper Thoracic Spine ◽  
Laser Interstitial Thermal Therapy ◽  
Symptomatic Recurrence ◽  
Sacral Chordoma ◽  
Spinal Radiosurgery ◽  
Spine Case ◽  
Upper Thoracic

The authors present the first report of laser interstitial thermal therapy (LITT) ablation of a recurrent chordoma metastasis to the cervical spine. This patient was a 75-year-old woman who was diagnosed and treated for a sacral chordoma, and then developed metastases to the lung and upper thoracic spine. Unfortunately she experienced symptomatic recurrence at the C-7 spinous process. She underwent an uncomplicated LITT to the lesion. The patient convalesced without incident and was discharged on postoperative Day 1. She received stereotactic spinal radiosurgery to the lesion at a dose of 24 Gy in 1 fraction. At the 3-month follow-up evaluation she had radiographic response and improvement in her symptoms.

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.

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.

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 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.

Translaminar screw fixation in the upper thoracic spine

2006 ◽  
Vol 5 (6) ◽  
pp. 527-533 ◽  
Author(s):  
Ryan M. Kretzer ◽  
Daniel M. Sciubba ◽  
Carlos A. Bagley ◽  
Jean-Paul Wolinsky ◽  
Ziya L. Gokaslan ◽  
...  
Keyword(s):  
Thoracic Spine ◽  
Pedicle Screws ◽  
Attractive Alternative ◽  
Rigid Fixation ◽  
Upper Thoracic Spine ◽  
Pull Out ◽  
Translaminar Screw ◽  
Upper Thoracic ◽  
Translaminar Screws

Object The use of pedicle screws (PSs) for instrument-assisted fusion in the cervical and thoracic spine has increased in recent years, allowing smaller constructs with improved biomechanical stability and repositioning possibilities. In the smaller pedicles of the upper thoracic spine, the placement of PSs can be challenging and may increase the risk of damage to neural structures. As an alternative to PSs, translaminar screws can provide spinal stability, and they may be used when pedicular anatomy precludes successful placement of PSs. The authors describe the technique of translaminar screw placement in the T-1 and T-2 vertebrae. Methods Seven patients underwent cervicothoracic fusion to treat trauma, neoplasm, or degenerative disease. Nineteen translaminar screws were placed, 13 at T-1 and six at T-2. A single asymptomatic T-2 screw violated the ventral laminar cortex and was removed. The mean clinical and radiographic follow up exceeded 14 months, at which time there were no cases of screw pull-out, screw fracture, or progressive kyphotic deformity. Conclusions Rigid fixation with translaminar screws offers an attractive alternative to PS fixation, allowing the creation of sound spinal constructs and minimizing potential neurological morbidity. Their use requires intact posterior elements, and care should be taken to avoid violation of the ventral laminar wall.

Balloon kyphoplasty in the treatment of metastatic tumors of the upper thoracic spine

2011 ◽  
Vol 14 (3) ◽  
pp. 372-376 ◽  
Author(s):  
Mohammed Eleraky ◽  
Ioannis Papanastassiou ◽  
Matthias Setzer ◽  
Ali A. Baaj ◽  
Nam D. Tran ◽  
...  
Keyword(s):  
Pain Relief ◽  
Thoracic Spine ◽  
Balloon Kyphoplasty ◽  
Metastatic Tumors ◽  
Kyphotic Angle ◽  
Upper Thoracic Spine ◽  
Vertebral Bodies ◽  
The Mean ◽  
Upper Thoracic

Object Balloon kyphoplasty has recently been shown to be effective in providing rapid pain relief and enhancing health-related quality of life in patients with metastatic spinal tumors. When performed to treat lesions of the upper thoracic spine, kyphoplasty poses certain technical challenges because of the smaller size of the pedicle and vertebral bodies. Fluoroscopic visualization is also difficult due to interference of the shoulder. The authors' objective in the present study was to evaluate their approach and the results of balloon kyphoplasty in the upper thoracic spine in patients with metastatic spinal disease. Methods Fourteen patients underwent kyphoplasty via an extrapedicular approach to treat metastatic tumors in the upper (T1–5) thoracic spine. Electrodiagnostic monitoring (somatosensory and motor evoked potentials) was used in 5 cases. Three levels were treated in 7 cases, 2 levels in 2 cases, and 1 level in 5 cases. In 3 cases access was bilateral, whereas in 11 cases access was unilateral. The procedure took an average of 25 minutes per treated level, and the mean amount of cement applied was 3 ml per level. Four patients were discharged from the hospital on the day of the procedure, and 10 patients went home after 24 hours. Results All patients exhibited marked improvement in mean visual analog scale scores (preoperative score 79 vs postoperative score 30, respectively) and Oswestry Disability Index scores (83 vs 33, respectively). The mean kyphotic angle was 25.03° preoperatively, whereas the mean postoperative angle was 22.65° (p > 0.3). At latest follow-up, the mean kyphotic angle did not differ significantly from the postoperative kyphotic angle (26.3°, p > 0.1). No neurological deficits or lung-related complications (pneumothorax or hemothorax) were encountered in any of the patients. Polymethylmethacrylate cement extravasations were observed in 3 (10%) of 30 treated vertebral bodies without any sequelae. By a mean follow-up of 16 months, no patients had experienced an adjacent-level fracture. Conclusions Balloon kyphoplasty of the upper thoracic spine via an extrapedicular approach is an efficient and safe minimally invasive procedure that may provide immediate and long-term pain relief and improvement in functional ability. It is technically challenging and has the potential for serious complications. With a fundamental knowledge of anatomy, as well as an ability to interpret fluoroscopy images, one can feasibly and safely perform balloon kyphoplasty in the upper thoracic spine.

scholarly journals SURG-03. COMBINATION LASER INTERSTITIAL THERMAL THERAPY PLUS SRS INCREASES TIME TO PROGRESSION FOR RECURRENT SRS-TREATED BRAIN METASTASES

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii203-ii203
Author(s):  
Matthew Grabowski ◽  
Eric Sankey ◽  
Ethan Srinivasan ◽  
Balint Otvos ◽  
Alex Scott ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Tumor Volume ◽  
Radiographic Progression ◽  
Radiation Necrosis ◽  
Thermal Therapy ◽  
Time To Progression ◽  
Index Lesion ◽  
Laser Interstitial Thermal Therapy ◽  
Prospective Trials

Abstract INTRODUCTION Laser interstitial thermal therapy (LITT) has evolved as an effective treatment for brain metastases (BM) failing stereotactic radiosurgery (SRS), and an alternative to open resection/repeat SRS. We sought to evaluate the efficacy of LITT+SRS in recurrent SRS-treated BM, and compare outcomes to LITT alone vs. repeat SRS. METHODS A multicenter, retrospective study was performed of patients with biopsy-proven BM recurrence after SRS. Patients were stratified by planned LITT+SRS vs. LITT alone vs. repeat SRS. Index lesion progression was determined by RANO criteria. RESULTS Forty-five patients fit inclusion, with a median follow-up of 7.3 months (range:1.1-30.5), age of 60 (range:37-86), KPS of 80 (range:60-100), and contrasted tumor volume (CTV) of 6.1cc (range:1.4-19.4). Histologies included NSCLC (44%), breast (24%), SCLC, melanoma, colon, and oroesophageal (< 10% each). Sixty-three percent of patients underwent LITT alone, 18% had repeat SRS, while 27% had LITT+SRS (post-LITT SRS). Median time to index lesion progression was greatest in the LITT+SRS group compared to LITT alone or repeat SRS (>23, 7.5, and 3.6 months, respectively [p=0.018]), as was overall survival (23.7, 5.9, and 7.0 months, respectively [p=0.023]). Age, sex, primary histology, CTV, and treatment strategy were univariate predictors of tumor progression; patients not treated with LITT+SRS were more likely to have index lesion progression (p=0.016). When controlling for histology and CTV in a multivariate model, patients not treated with LITT+SRS were significantly more likely to have progression (p=0.001). All LITT+SRS patients who experienced subsequent radiographic progression were diagnosed with recurrent tumor, while radiation necrosis incidence in the repeat SRS arm was 25%. CONCLUSION LITT+SRS appears superior to LITT alone or repeat SRS for treatment of biopsy-proven BM recurrence after SRS when controlling for other variables known to be predictive of progression. Prospective trials should be designed to validate the utility of combination LITT+SRS after SRS failure.

scholarly journals Stereotactic laser interstitial thermal therapy for epilepsy associated with solitary and multiple cerebral cavernous malformations

2020 ◽  
Vol 48 (4) ◽  
pp. E12
Author(s):  
David Satzer ◽  
James X. Tao ◽  
Naoum P. Issa ◽  
Ziyi Chen ◽  
Shasha Wu ◽  
...  
Keyword(s):  
Brain Mri ◽  
Thermal Therapy ◽  
Seizure Freedom ◽  
Lesion Volume ◽  
Complication Rates ◽  
Cavernous Malformations ◽  
Laser Interstitial Thermal Therapy ◽  
Ablation Volume ◽  
Multifocal Lesions

OBJECTIVEThe authors sought to perform a preliminary assessment of the safety and effectiveness of stereotactic laser interstitial thermal therapy (LITT) for patients with cerebral cavernous malformation (CCM)–related epilepsy.METHODSThe authors retrospectively analyzed 6 patients with CCM-related epilepsy who underwent LITT. Pre-, intra-, and postoperative brain MRI studies were used to characterize preoperative CCM volume, ablation volume, and postablation hemosiderin volume. Clinical outcomes were assessed postoperatively during clinic follow-up visits or phone interviews.RESULTSLITT was performed in 7 CCMs in 6 patients. Two patients had familial CCM disease with multifocal lesions. Four treated CCMs were extratemporal, and 3 were in or near the visual pathways. The median follow-up was 25 (range 12–39) months. Five of 6 (83%) patients achieved seizure freedom (Engel I classification), of whom 4 (67%) were Engel IA and 1 was Engel IC after a single seizure on postoperative day 4. The remaining patient had rare seizures (Engel II). One patient had a nondisabling visual field deficit. There were no hemorrhagic complications. All patients were discharged within 24 hours postablation. MRI 3–11 months after ablation demonstrated expected focal necrosis and trace hemosiderin-related T2 hypointensity measuring 9%–44% (median 24%) of the original lesion volume, with significant (p = 0.04) volume reduction.CONCLUSIONSLITT is a minimally invasive option for treating CCM-related epilepsy with seizure outcomes comparable to those achieved with open lesionectomy. The precision of LITT allows for the obliteration of eloquent, deep, small, and multifocal lesions with low complication rates, minimal postoperative discomfort, and short hospital stays. In this study the feasibility and benefits of this method were demonstrated in 2 patients with multifocal lesions.

scholarly journals SURG-25. LASER INTERSTITIAL THERMAL THERAPY (LITT) FOR INTRACRANIAL LESIONS: A SINGLE- INSTITUTIONAL SERIES, OUTCOMES AND REVIEW OF THE LITERATURE

2019 ◽  
Vol 21 (Supplement_6) ◽  
pp. vi244-vi245
Author(s):  
Rocco Dabecco ◽  
Alexander Yu ◽  
Tulika Ranjan ◽  
Linda Xu ◽  
Khaled Aziz
Keyword(s):  
Minimally Invasive ◽  
Brain Metastases ◽  
Metastatic Disease ◽  
Progression Free Survival ◽  
Treatment Method ◽  
Thermal Therapy ◽  
Minimally Invasive Treatment ◽  
Invasive Treatment ◽  
Laser Interstitial Thermal Therapy

Abstract INTRODUCTION Laser interstitial thermal therapy (LITT) is a minimally invasive treatment method that provides surgeons with cytoreductive techniques to treat neurosurgical conditions such as primary brain neoplasms, brain metastases, radiation necrosis, and epileptogenic lesions, many of which are located in operative corridors that would be difficult to address via open surgical or are amenable via minimally invasive approaches. Although the use of lasers is not a new concept in neurosurgery, advances in technology have enabled surgeons to perform laser treatment with the aid of real-time MRI thermography as a guide. In this report, we present our institutional series and outcomes of patients treated with LITT for 8 glial neoplasms 12 brain metastases. METHODS We retrospectively evaluated 20 patients (7 male, 13 female; age range, 28–77 years) who underwent LITT at one or more targets from 2015–2019. RESULTS In our series, all patients included had prior craniotomy for either primary glioma or metastatic disease. Mean extent of ablation (EOA) was 98% on post-op MRI. Mean progression free survival varied depending on the intracranial pathology, with the glioma cohort (5 months (SDD: 3.51)) demonstrating worse outcomes than metastatic disease (8.2 months (SDD: 4.83)). Only 1 patient experienced immediate post-operative morbidity, 1 patient experienced post-operative mortality secondary to hemorrhage. Mean follow-up was 9.7 months (SDD: 5.35), with one patient lost to follow up immediately post-procedure and excluded from the study. Average hospitalization was 2.4 days (SDD: 1.0). Mean overall survival, post-diagnosis of intracranial lesion, is more favorable for metastatic lesions (48 months (SDD: 27.14)), as compared to primary glial neoplasms (31 months SDD: 11.63)). CONCLUSION Laser interstitial thermal therapy (LITT) is a safe, minimally invasive treatment method that provides surgeons with cytoreductive techniques to treat neurosurgical conditions. In properly selected patients, this modality offers improved survival outcomes in conjunction with other salvage therapies.

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