scholarly journals Biopsy Artifact in Laser Interstitial Thermal Therapy: A Technical Note

2021 ◽  
Vol 11 ◽  
Author(s):  
Thomas Noh ◽  
Parikshit Juvekar ◽  
Raymond Huang ◽  
Gunnar Lee ◽  
Christian T. Ogasawara ◽  
...  
Keyword(s):  
Thermal Damage ◽  
Technical Note ◽  
Thermal Therapy ◽  
Ct Scans ◽  
Additional Consideration ◽  
Temperature Mapping ◽  
Laser Interstitial Thermal Therapy ◽  
Susceptibility Effects ◽  
Biopsy Artifact ◽  
Signal Dropout

PurposeThe safety and effectiveness of laser interstitial thermal therapy (LITT) relies critically on the ability to continuously monitor the ablation based on real-time temperature mapping using magnetic resonance thermometry (MRT). This technique uses gradient recalled echo (GRE) sequences that are especially sensitive to susceptibility effects from air and blood. LITT for brain tumors is often preceded by a biopsy and is anecdotally associated with artifact during ablation. Thus, we reviewed our experience and describe the qualitative signal dropout that can interfere with ablation.MethodsWe retrospectively reviewed all LITT cases performed in our intraoperative MRI suite for tumors between 2017 and 2020. We identified a total of 17 LITT cases. Cases were reviewed for age, sex, pathology, presence of artifact, operative technique, and presence of blood/air on post-operative scans.ResultsWe identified six cases that were preceded by biopsy, all six had artifact present during ablation, and all six were noted to have air/blood on their post-operative MRI or CT scans. In two of those cases, the artifactual signal dropout qualitatively interfered with thermal damage thresholds at the borders of the tumor. There was no artifact in the 11 non-biopsy cases and no obvious blood or air was noted on the post-ablation scans.ConclusionAdditional consideration should be given to pre-LITT biopsies. The presence of air/blood caused an artifactual signal dropout effect in cases with biopsy that was severe enough to interfere with ablation in a significant number of those cases. Additional studies are needed to identify modifying strategies.

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 NIMG-68. MATHEMATICAL MODELING OF THERMAL DAMAGE ESTIMATE VOLUMES IN MAGNETIC RESONANCE-GUIDED LASER INTERSTITIAL THERMAL THERAPY

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii163-ii163
Author(s):  
Allison Liang ◽  
Sean Munier ◽  
Shabbar Danish
Keyword(s):  
Magnetic Resonance ◽  
Thermal Damage ◽  
Invasive Procedure ◽  
Thermal Therapy ◽  
Definite Integral ◽  
Strongly Correlated ◽  
Dual Plane ◽  
Laser Interstitial Thermal Therapy ◽  
Integral Methods ◽  
Ablation Volume

Abstract BACKGROUND Magnetic resonance-guided laser interstitial thermal therapy is a minimally invasive procedure that produces real-time thermal damage estimates of ablation (TDE). Orthogonal TDE-MRI slices provides an opportunity to mathematically estimate ablation volume. OBJECTIVE To mathematically model TDE volumes and validate with post-24 hours MRI ablation volumes. METHODS Ablations were performed with the Visualase Laser Ablation System (Medtronic). Using ellipsoidal parameters determined for dual-TDEs from orthogonal MRI planes, TDE volumes were calculated by two definite integral methods (A and B) implemented in Matlab (MathWorks). Post 24-hours MRI ablative volumes were measured in OsiriX (Pixmeo) by two-blinded raters and compared to TDE volumes via paired t-tests and Pearson’s correlations. RESULTS Twenty-two ablations for 20 patients with various intracranial pathologies were included. Average TDE volumes calculated with Method A was 3.44 ± 1.96 cm3 and with Method B was 4.83 ± 1.53 cm3. Method A TDE volumes were significantly different than post-24 hours volumes (P < 0.001). Method B TDE volumes were not significantly different than post-24 hours volumes (P = 0.39) and strongly correlated with each other (r = 0.85, R2 = 0.72, P < 0.0001). A total of 8/22 (36%) method A versus 17/22 (77%) method B TDE volumes were within 25% of the post 24-hours ablative volume. CONCLUSION We present the first iteration of a viable mathematical method that integrates dual-plane TDEs to calculate volumes resembling 24 hours post-operative volumes. Future iterations of our algorithm will need to determine additional calculated variables that improve the performance of volumetric calculations.

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

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.

scholarly journals A Novel Computational Approach in MATLAB to Characterize Thermal Damage Estimate in Magnetic Resonance-Guided Laser Interstitial Thermal Therapy

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Allison Liang ◽  
Sean Munier ◽  
Shabbar F Danish
Keyword(s):  
Magnetic Resonance ◽  
Thermal Damage ◽  
Invasive Procedure ◽  
Thermal Therapy ◽  
Value Differences ◽  
Laser Interstitial Thermal Therapy ◽  
Large Sets ◽  
The Mean ◽  
Mean Differences ◽  
Student’S T

Abstract INTRODUCTION Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) is a minimally invasive procedure that produces real-time thermal damage estimate (TDE) of the ablative area. Measurements of TDE by hand across a full ablation can be time-consuming, and currently, no reliable image analysis exists for measuring TDE dimensions efficiently. METHODS Ablations were performed with the Visualase MRI-Guided Laser Ablation System (Medtronic). Selection criteria included single-laser catheter use and available ablation data in 2 planes. Central TDE lengths and widths postsingle ablation dose were calculated using our developed MATLAB algorithm and compared to manual measurements by 2 raters. The Bland-Altman model and Student's t-tests were used to characterize value differences between the 2 methods. RESULTS A total of 42 TDE images across 21 patients were included. The mean differences in TDE length for rater 1 vs algorithm, rater 2 vs algorithm, and rater 1 vs rater 2 were −0.12 mm (SEM = 0.18), −0.54 mm (SEM = 0.17), and 0.42 mm (SEM = 0.17), respectively. The mean difference in TDE width for rater 1 vs algorithm, rater 2 vs algorithm, and rater 1 vs rater 2 were 0.45 mm (SEM = 0.16), −0.46 mm (SEM = 0.16), and 0.91 mm (SEM = 0.12), respectively. For both lengths and widths, student's t-tests show no significance differences across rater 1 and rater 2 vs algorithm (P > .1) and between raters (P > .05). CONCLUSION Our iterative algorithm provides a reliable method for calculating TDE dimensions. Compared to manual measurements, the differences in TDE length and width are negligible. This computational tool allows for measurement of TDE for large sets of MRgLITT data within minutes.

Temperature mapping of magnetic resonance-guided laser interstitial thermal therapy (LITT) in lymphangiomas of the head and neck

2000 ◽  
Vol 26 (5) ◽  
pp. 467-476 ◽  
Author(s):  
Gerold K.H. Eyrich ◽  
Elisabeth Bruder ◽  
Paul Hilfiker ◽  
Benjamin Dubno ◽  
Harald H. Quick ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Head And Neck ◽  
Thermal Therapy ◽  
Temperature Mapping ◽  
Laser Interstitial Thermal Therapy

Spinal laser interstitial thermal therapy: single-center experience and outcomes in the first 120 cases

2020 ◽  
pp. 1-10
Author(s):  
Dhiego C. A. Bastos ◽  
Rafael A. Vega ◽  
Jeffrey I. Traylor ◽  
Amol J. Ghia ◽  
Jing Li ◽  
...  
Keyword(s):  
Local Recurrence ◽  
Local Control ◽  
Thoracic Spine ◽  
Adjuvant Radiotherapy ◽  
Neurological Complications ◽  
Thermal Therapy ◽  
External Beam Radiation ◽  
Beam Radiation ◽  
Laser Interstitial Thermal Therapy ◽  
Hazard Ratios

OBJECTIVEThe objective of this study was to present the results of a consecutive series of 120 cases treated with spinal laser interstitial thermal therapy (sLITT) to manage epidural spinal cord compression (ESCC) from metastatic tumors.METHODSThe electronic records of patients treated from 2013 to 2019 were analyzed retrospectively. Data collected included demographic, pathology, clinical, operative, and imaging findings; degree of epidural compression before and after sLITT; length of hospital stay; complications; and duration before subsequent oncological treatment. Independent-sample t-tests were used to compare means between pre- and post-sLITT treatments. Survival was estimated by the Kaplan-Meier method. Multivariate logistic regression was used to analyze predictive factors for local recurrence and neurological complications.RESULTSThere were 110 patients who underwent 120 sLITT procedures. Spinal levels treated included 5 cervical, 8 lumbar, and 107 thoracic. The pre-sLITT Frankel grades were E (91.7%), D (6.7%), and C (1.7%). The preoperative ESCC grade was 1c or higher in 92% of cases. Metastases were most common from renal cell carcinoma (39%), followed by non–small cell lung carcinoma (10.8%) and other tumors (35%). The most common location of ESCC was in the vertebral body (88.3%), followed by paraspinal/foraminal (7.5%) and posterior elements (4.2%). Adjuvant radiotherapy (spinal stereotactic radiosurgery or conventional external beam radiation therapy) was performed in 87 cases (72.5%), whereas 33 procedures (27.5%) were performed as salvage after radiotherapy options were exhausted. sLITT was performed without need for spinal stabilization in 87 cases (72.5%). Post-sLITT Frankel grades were E (85%), D (10%), C (4.2%), and B (0.8%); treatment was associated with a median decrease of 2 ESCC grades. The local control rate at 1 year was 81.7%. Local control failure occurred in 25 cases (20.8%). The median progression-free survival was not reached, and overall survival was 14 months. Tumor location in the paraspinal region and salvage treatment were independent predictors of local recurrence, with hazard ratios of 6.3 and 3.3, respectively (p = 0.01). Complications were observed in 22 cases (18.3%). sLITT procedures performed in the lumbar and cervical spine had hazard ratios for neurological complications of 15.4 and 17.1 (p < 0.01), respectively, relative to the thoracic spine.CONCLUSIONSsLITT is safe and provides effective local control for high-grade ESCC from vertebral metastases in the thoracic spine, particularly when combined with adjuvant radiotherapy. The authors propose considering sLITT as an alternative to open surgery in selected patients with spinal metastases.

scholarly journals SURG-13. LASER INTERSTITIAL THERMAL THERAPY FOR RECURRENT GLIOBLASTOMA: A REVIEW OF SURVIVAL OUTCOMES COMPARED TO A MATCHED SURGICAL COHORT

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii206-ii206
Author(s):  
Hassan Fadel ◽  
Sameah Haider ◽  
Jacob Pawloski ◽  
Hesham Zakaria ◽  
Farhan Chaudhry ◽  
...  
Keyword(s):  
Surgical Resection ◽  
Subgroup Analysis ◽  
Tumor Volume ◽  
Progression Free Survival ◽  
Recurrent Glioblastoma ◽  
Thermal Therapy ◽  
Survival Outcomes ◽  
Repeat Surgery ◽  
Laser Interstitial Thermal Therapy ◽  
Recurrent Gbm

Abstract INTRODUCTION Glioblastoma (GBM) is uniformly associated with a poor prognosis and inevitable recurrence. Management of recurrent GBM remains unclear, with repeat surgery often employed with varying degrees of success. We evaluated the efficacy of Laser Interstitial Thermal Therapy (LITT) for recurrent GBM when compared to a carefully matched cohort of patients treated with repeat surgical resection. METHODS A retrospective single-institution database was used to identify patients who underwent LITT or surgical resection of recurrent GBM between 2014-2019. LITT patients were matched with surgical resection patients according to baseline demographics, comorbidities, tumor location, and eloquence. Subgroup analysis matching similar patients for tumor volume was also completed. Overall survival (OS) and progression-free survival (PFS) were the primary endpoints. RESULTS A LITT cohort of 20 patients was matched to 50 similar patients who underwent repeat surgical resection. Baseline characteristics were similar between both cohorts apart from tumor volume, which was larger in the surgical cohort (17.5 cc vs. 4.7 cc, p&lt; 0.01). On long-term follow-up, there was no difference in OS (HR, 0.72; 95%CI, 0.36-1.45) or PFS (HR, 0.67; 95%CI, 0.29-1.53) between the LITT and surgical cohorts when controlling for tumor volume. Subgroup analysis of 23 LITT patients matched according to tumor volume with 23 surgical patients with similar clinical characteristics also found no difference in OS (HR, 0.66; 95%CI, 0.33-1.30) or PFS (HR, 0.58; 95%CI, 0.90-1.05) between the cohorts. LITT patients had shorter length of stays (1 vs. 4 days, p&lt; 0.001) and a higher rate of home discharge (84% vs. 67%, p=0.172) compared to the surgical cohort. CONCLUSION After matching for demographic, clinical, and tumor characteristics, there was no difference in outcomes between patients undergoing LITT compared to surgical resection for recurrent GBM. LITT patients had similar survival outcomes yet shorter hospital stays and more favorable dispositions, potentially mitigating post-treatment complications.

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