scholarly journals Magnetic resonance imaging–guided laser interstitial thermal therapy for previously treated hypothalamic hamartomas

2016 ◽  
Vol 41 (4) ◽  
pp. E8 ◽  
Author(s):  
Anthony M. Burrows ◽  
W. Richard Marsh ◽  
Gregory Worrell ◽  
David A. Woodrum ◽  
Bruce E. Pollock ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Minimally Invasive ◽  
Thermal Therapy ◽  
Seizure Freedom ◽  
Resonance Imaging ◽  
Gelastic Seizures ◽  
Laser Interstitial Thermal Therapy ◽  
Hypothalamic Hamartomas

OBJECTIVE Hypothalamic hamartomas (HHs) are associated with gelastic seizures and the development of medically refractory epilepsy. Magnetic resonance imaging–guided laser interstitial thermal therapy (MRg-LITT) is a minimally invasive ablative treatment that may have applicability for these deep-seated lesions. Here, the authors describe 3 patients with refractory HHs who they treated with MRg-LITT. METHODS An institutional review board–approved prospective database of patients undergoing Visualase MRg-LITT was retrospectively reviewed. Demographic and historical medical data, including seizure and medication histories, previous surgeries, procedural details, and surgical complications, along with radiological interpretation of the HHs, were recorded. The primary outcome was seizure freedom, and secondary outcomes included medication reduction, seizure frequency, operative morbidity, and clinical outcome at the latest follow-up. RESULTS All 3 patients in the multi-institutional database had developed gelastic seizures related to HH at the ages of 7, 7, and 9 years. They presented for further treatment at 25, 28, and 48 years of age, after previous treatments with stereotactic radiosurgery in all cases and partial hamartoma resection in one case. One ablation was complicated by a small tract hemorrhage, which was stable on postoperative imaging. One patient developed hyponatremia and experienced weight gain, which were respectively managed with fluid restriction and counseling. At the most recent follow-up at a mean of 21 months (range 1–32 months), one patient was seizure free while another had meaningful seizure reduction. Medication was reduced in one case. CONCLUSIONS Adults with gelastic seizures despite previous treatments can undergo MRg-LITT with reasonable safety and efficacy. This novel therapy may provide a minimally invasive alternative for primary and recurrent HH as the technique is refined.

scholarly journals Magnetic Resonance Imaging-Guided Focused Laser Interstitial Thermal Therapy for Intracranial Lesions

Neurosurgery ◽  
2013 ◽  
Vol 73 (6) ◽  
pp. 1007-1017 ◽  
Author(s):  
Ammar H. Hawasli ◽  
Swapnil Bagade ◽  
Joshua S. Shimony ◽  
Michelle Miller-Thomas ◽  
Eric C. Leuthardt
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Treatment Option ◽  
Progression Free Survival ◽  
Thermal Therapy ◽  
Seizure Freedom ◽  
Resonance Imaging ◽  
Laser Interstitial Thermal Therapy ◽  
Imaging Characteristics ◽  
Intracranial Lesions

Abstract BACKGROUND: Surgical treatments for deep-seated intracranial lesions have been limited by morbidities associated with resection. Real-time magnetic resonance imaging–guided focused laser interstitial thermal therapy (LITT) offers a minimally invasive surgical treatment option for such lesions. OBJECTIVE: To review treatments and results of patients treated with LITT for intracranial lesions at Washington University School of Medicine. METHODS: In a review of 17 prospectively recruited LITT patients (34–78 years of age; mean, 59 years), we report demographics, treatment details, postoperative imaging characteristics, and peri- and postoperative clinical courses. RESULTS: Targets included 11 gliomas, 5 brain metastases, and 1 epilepsy focus. Lesions were lobar (n = 8), thalamic/basal ganglia (n = 5), insular (n = 3), and corpus callosum (n = 1). Mean target volume was 11.6 cm3, and LITT produced 93% target ablation. Patients with superficial lesions had shorter intensive care unit stays. Ten patients experienced no perioperative morbidities. Morbidities included transient aphasia, hemiparesis, hyponatremia, deep venous thrombosis, and fatal meningitis. Postoperative magnetic resonance imaging showed blood products within the lesion surrounded by new thin uniform rim of contrast enhancement and diffusion restriction. In conjunction with other therapies, LITT targets often showed stable or reduced local disease. Epilepsy focus LITT produced seizure freedom at 8 months. Preliminary overall median progression-free survival and survival from LITT in tumor patients were 7.6 and 10.9 months, respectively. However, this small cohort has not been followed for a sufficient length of time, necessitating future outcomes studies. CONCLUSION: Early peri- and postoperative clinical data demonstrate that LITT is a safe and viable ablative treatment option for intracranial lesions, and may be considered for select patients.

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.

scholarly journals Journal Club: Magnetic Resonance Imaging-Guided Focused Laser Interstitial Thermal Therapy for Intracranial Lesions

Neurosurgery ◽  
2014 ◽  
Vol 74 (5) ◽  
pp. 562-564
Author(s):  
Pratik Rohatgi ◽  
Brian Anderson ◽  
Einar Bogason ◽  
Nicholas Brandmeir ◽  
Ephraim Church ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Journal Club ◽  
Thermal Therapy ◽  
Resonance Imaging ◽  
Laser Interstitial Thermal Therapy ◽  
Intracranial Lesions

scholarly journals Laser Interstitial Thermal Therapy Technology, Physics of Magnetic Resonance Imaging Thermometry, and Technical Considerations for Proper Catheter Placement During Magnetic Resonance Imaging–Guided Laser Interstitial Thermal Therapy

Neurosurgery ◽  
2016 ◽  
Vol 79 (suppl_1) ◽  
pp. S8-S16 ◽  
Author(s):  
Nitesh V. Patel ◽  
Matthew Mian ◽  
R. Jason Stafford ◽  
Brian V. Nahed ◽  
Jon T. Willie ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Treatment Algorithm ◽  
Thermal Therapy ◽  
Catheter Placement ◽  
Clear Understanding ◽  
Resonance Imaging ◽  
Laser Interstitial Thermal Therapy ◽  
Basic Physics ◽  
Intracranial Lesions

Abstract Laser-induced thermal therapy has become a powerful tool in the neurosurgical armamentarium. The physics of laser therapy are complex, but a sound understanding of this topic is clinically relevant, as many centers have incorporated it into their treatment algorithm, and educated patients are demanding consideration of its use for their disease. Laser ablation has been used for a wide array of intracranial lesions. Laser catheter placement is guided by stereotactic planning; however, as the procedure has popularized, the number of ways in which the catheter can be inserted has also increased. There are many technical nuances for laser placement, and, to date, there is not a clear understanding of whether any one technique is better than the other. In this review, we describe the basic physics of magnetic resonance–guided laser-induced thermal therapy and describe the several common techniques for accurate Visualase laser catheter placement in a stepwise fashion.

Magnetic Resonance Imaging-Guided Focused Laser Interstitial Thermal Therapy for Subinsular Metastatic Adenocarcinoma: Technical Case Report

2011 ◽  
Vol 70 (suppl_2) ◽  
pp. onsE332-onsE338 ◽  
Author(s):  
Ammar H. Hawasli ◽  
Wilson Z. Ray ◽  
Rory K.J. Murphy ◽  
Ralph G. Dacey ◽  
Eric C. Leuthardt
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Image Guidance ◽  
Gamma Knife Radiosurgery ◽  
Thermal Therapy ◽  
Intraoperative Mri ◽  
Metastatic Adenocarcinoma ◽  
Resonance Imaging ◽  
Laser Interstitial Thermal Therapy ◽  
Whole Brain Radiation

ABSTRACT BACKGROUND AND IMPORTANCE: To describe the novel use of the AutoLITT System (Monteris Medical, Winnipeg, Manitoba, Canada) for focused laser interstitial thermal therapy (LITT) with intraoperative magnetic resonance imaging (MRI) and stereotactic image guidance for the treatment of metastatic adenocarcinoma in the left insula. CLINICAL PRESENTATION: The patient was a 61-year-old right-handed man with a history of metastatic adenocarcinoma of the colon. He had previously undergone resection of multiple lesions, Gamma Knife radiosurgery, and whole-brain radiation. Despite treatment of a left insular tumor, serial imaging revealed that the lesion continued to enlarge. Given the refractory nature of this tumor to radiation and the deep-seated location, the patient elected to undergo LITT treatment. The center of the lesion and entry point on the scalp were identified with STEALTH (Medtronic, Memphis, Tennessee) image-guided navigation. The AXiiiS Stereotactic Miniframe (Monteris Medical) for the LITT system was secured onto the skull, and a trajectory was defined to achieve access to the centroid of the tumor. After a burr hole was made, a gadolinium template probe was inserted into the AXiiiS base. The trajectory was confirmed via an intraoperative MRI, and the LITT probe driver was attached to the base and CO2-cooled, side-firing laser LITT probe. The laser was activated and thermometry images were obtained. Two trajectories, posteromedial and anterolateral, produced satisfactory tumor ablation. CONCLUSION: LITT with intraoperative MRI and stereotactic image guidance is a newly available, minimally invasive, and therapeutically viable technique for the treatment of deep seated brain tumors.

scholarly journals Glioblastoma Treated With Magnetic Resonance Imaging-Guided Laser Interstitial Thermal Therapy: Safety, Efficacy, and Outcomes

Neurosurgery ◽  
2018 ◽  
Vol 84 (4) ◽  
pp. 836-843 ◽  
Author(s):  
Ashwin A Kamath ◽  
Daniel D Friedman ◽  
S Hassan A Akbari ◽  
Albert H Kim ◽  
Yu Tao ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Thermal Therapy ◽  
Resonance Imaging ◽  
Laser Interstitial Thermal Therapy

A novel use of the NeuroBlate SideFire probe for minimally invasive disconnection of a hypothalamic hamartoma in a child with gelastic seizures

2018 ◽  
Vol 21 (3) ◽  
pp. 302-307 ◽  
Author(s):  
James M. Wright ◽  
Michael D. Staudt ◽  
Andrea Alonso ◽  
Jonathan P. Miller ◽  
Andrew E. Sloan
Keyword(s):  
Magnetic Resonance Imaging ◽  
Laser Ablation ◽  
Magnetic Resonance ◽  
Minimally Invasive ◽  
Perioperative Complications ◽  
Hypothalamic Hamartoma ◽  
Proof Of Concept ◽  
Resonance Imaging ◽  
Gelastic Seizures ◽  
Antiepileptic Medications

The authors describe the case of a 22-month-old boy who presented with gelastic seizures and developmental delay. Magnetic resonance imaging and video-electroencephalography monitoring revealed a primarily intraventricular hypothalamic hamartoma and gelastic seizures occurring 20–30 times daily. The patient was treated with various regimens of antiepileptic medications for 16 months, but the seizures remained medically intractable. At 3 years of age, he underwent stereotactic laser ablation with an aim of disconnection of the lesion. The procedure was performed with the NeuroBlate SideFire probe. To the authors’ knowledge, this is the first reported use of this technology for this procedure and serves as proof of concept. There were no perioperative complications, and 2 years postprocedure, the patient remains seizure free with marked behavioral and cognitive improvements.

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