Current applications and safety profile of laser interstitial thermal therapy in the pediatric population: a systematic review of the literature

Abstract

OBJECTIVE Laser interstitial thermal therapy (LITT) provides a minimally invasive alternative to open brain surgery, making it a powerful neurosurgical tool especially in pediatric patients. This systematic review aimed to highlight the indications and complications of LITT in the pediatric population. METHODS In line with the PRISMA guidelines, the authors conducted a systematic review to summarize the current applications and safety profiles of LITT in pediatrics. PubMed and Embase were searched for studies that reported the outcomes of LITT in patients < 21 years of age. Retrospective studies, case series, and case reports were included. Two authors independently screened the articles by title and abstract followed by full text. Relevant variables were extracted from studies that met final eligibility, and results were pooled using descriptive statistics. RESULTS The selection process captured 303 pediatric LITT procedures across 35 studies. Males comprised approximately 60% of the aggregate sample, with a mean age of 10.5 years (range 0.5–21 years). The LITT technologies used included Visualase (89%), NeuroBlate (9%), and Multilase 2100 (2%). The most common indication was treatment of seizures (86%), followed by brain tumors (16%). The mean follow-up duration was 15.6 months (range 1.3–48 months). The overall complication rate was 15.8%, which comprised transient neurological deficits, cognitive and electrolyte disturbances, hemorrhage, edema, and hydrocephalus. No deaths were reported. CONCLUSIONS As of now, LITT’s most common applications in pediatrics are focused on treating medically refractory epilepsy and brain tumors that can be difficult to resect. The safety of LITT can provide an attractive alternative to open brain surgery in the pediatric population.

Laser interstitial thermal therapy (LITT) for pediatric patients affected by intracranial tumors

“…The fiber was repositioned using the same system in the same operating session, and the procedure was completed with good outcomes (Figure 4). Malposition is already described in adults and children, mainly depending on a technical failure and should be considered a possible complication of hemorrhage, ineffective ablation, and reoperation (6,(8)(9)(10)(11)(12). In our series, we observed no mortality or long-term morbidity.…”

“…Ahluwalia et al (13) stated that "no unanticipated adverse events occurred" in their adult series. The complications reported have primarily been bleeding, transient or permanent deficits related to proximity to eloquent areas, and edema, with no significant differences in adults and pediatric series (3,(6)(7)(8)(9)(10)(13)(14)(15)(16)(17). We experienced two transient power worsening in two cases of thalamic tumors, with complete recovery at 1 month.…”

“…These studies have shown that LITT offers good results for disease control with very low risks in the long term for LGG (WHO I-II) and encouraging results for HGG (WHO III-IV) with extended survival in recurrent or residual tumors in patients who are refractory to other treatments and not suitable for reoperation ( 7 , 8 ). Moreover, most treated and described pediatric cases are associated with epilepsy (86%), with oncologic cases accounting for only 16% ( 9 ). Therefore, it is inappropriate to directly transfer these results to pediatric neurooncological patients.…”

Efficacy of laser interstitial thermal therapy (LITT) for newly diagnosed and recurrent IDH wild-type glioblastoma

“…AEs were also similar to prior reports. 24 AEs occurred in 13.5% (12/89) of patients ( Table 2 ). Twelve AEs were adjudicated as procedure-related by the safety committee.…”

Stealth Autoguide for robotic-assisted laser ablation for lesional epilepsy: illustrative case

“…3,[5][6][7][8][9] Laser interstitial thermal therapy (LITT) is an intervention that allows for minimally invasive tissue ablation for both tumor and epilepsy surgery. [10][11][12][13][14][15][16][17][18][19] Unfortunately, the added complexity of using magnetic resonance imaging (MRI) to monitor thermal ablations in real time has made procedure efficiency challenging. 20 The Stealth Autoguide (Medtronic) robot is a promising stereotactic robot that can increase accuracy and efficiency.…”