Renaissance of laser interstitial thermal ablation

Missios, Symeon; Bekelis, Kimon; Barnett, Gene H.

doi:10.3171/2014.12.focus14762

Cited by 162 publications

(127 citation statements)

References 55 publications

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“…Two MRgLITT systems are currently approved by the Food and Drug Administration (FDA) for clinical use in the United States: Visualase (Medtronic, Minneapolis, MN) and NeuroBlate (Monteris Medical, Plymouth, NM). Although these systems are built around the same concept, there are differences between them, including computerguided robotic catheter movement, directional manipulation of thermal energy, and low-temperature safety controls to protect critical structures from injury (78,79). Advantages of MRgLITT include the ability to target deep lesions (e.g., hypothalamic hamartomas, mesial temporal sclerosis) via a minimally invasive approach and monitoring of the treatment in real time.…”

Section: Mri-guided Laser Interstitial Thermal Therapy (Mrglitt)mentioning

confidence: 99%

“…Specifically, MRgLITT has been an exciting new minimally invasive tool in the management of a variety of neurosurgical lesions, especially DRE in children (Tables 1 and 3). MRgLITT utilizes an optical fiber with a diffusing tip heated by a diode laser insulated in an outer cannula that cools the laser with either saline or carbon dioxide (78). The probe is delivered by frame-based stereotaxis, robotic stereotaxis, or MRI-based frameless stereotactic techniques to a defined target.…”

Section: Mri-guided Laser Interstitial Thermal Therapy (Mrglitt)mentioning

confidence: 99%

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Emerging surgical therapies in the treatment of pediatric epilepsy

Karsy¹,

Guan²,

Ducis³

et al. 2016

Transl. Pediatr.

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Abstract:In the approximately 1% of children affected by epilepsy, pharmacoresistance and early age of seizure onset are strongly correlated with poor cognitive outcomes, depression, anxiety, developmental delay, and impaired activities of daily living. These children often require multiple surgical procedures, including invasive diagnostic procedures with intracranial electrodes to identify the seizure-onset zone. The recent development of minimally invasive surgical techniques, including stereotactic electroencephalography (SEEG) and MRI-guided laser interstitial thermal therapy (MRgLITT), and new applications of neurostimulation, such as responsive neurostimulation (RNS), are quickly changing the landscape of the surgical management of pediatric epilepsy. In this review, the authors discuss these various technologies, their current applications, and limitations in the treatment of pediatric drug-resistant epilepsy, as well as areas for future research. The development of minimally invasive diagnostic and ablative surgical techniques together with new paradigms in neurostimulation hold vast potential to improve the efficacy and reduce the morbidity of the surgical management of children with drug-resistant epilepsy.

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Section: Mri-guided Laser Interstitial Thermal Therapy (Mrglitt)mentioning

confidence: 99%

Section: Mri-guided Laser Interstitial Thermal Therapy (Mrglitt)mentioning

confidence: 99%

Emerging surgical therapies in the treatment of pediatric epilepsy

Karsy¹,

Guan²,

Ducis³

et al. 2016

Transl. Pediatr.

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“…Carpentier et al [24] also noted a similar radiographic increase in lesion volume up to two weeks, followed by steady regression. A number of groups have attempted a formal assessment of MRI patterns following LITT [39]. Initial images are frequently characterized by decreased contrast enhancement within the center of the lesion; this is surrounded peripherally with a contrast-enhancing margin, which confers an "eggshell-like" appearance to the lesions [33].…”

Section: Discussionmentioning

confidence: 99%

Laser Interstitial Thermal Therapy for Radiation Necrosis/Adverse Inflammatory Responses to SRS - Case Report and Literature Review

Tsvankin¹,

Howell²,

Fecci³

2017

JNSK

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Brain metastases are the most common type of intracranial tumor, and confer a dismal prognosis. Morbidity in these patients arises not only from tumor burden but from treatment-related toxicities. Among the most significant of these is radiation necrosis, a common sequelae of stereotactic radiosurgery that may cause neurologic impairment through mass effect or steroid-refractory edema. Truly, "radiation necrosis" is a misnomer, as the process is more accurately an adverse inflammatory response post-stereotactic radiotherapy (AIRS). Because it is impossible to reliably distinguish AIRS from tumor recurrence without a biopsy, and because high-dose steroids are poorly tolerated, management of AIRS poses a significant therapeutic challenge. Laser interstitial thermal therapy (LITT) is an emerging minimally-invasive treatment modality which uses hyperthermia to ablate intracranial pathologic tissues. Here, we describe the use of LITT in a patient with steroid-refractory AIRS following radiosurgery for a right supplementary motor area metastatic focus, and provide a brief review of the utility of LITT in patients with AIRS. direct heat application across the lesion volume, resulting in controlled cell death [30]. In contrast to open surgery, LITT can be performed through the same basic operating platform as a biopsy, allowing the neurosurgeon to avoid the risk of performing a craniotomy. The incision is less than 1cm long; at our institution, patients do not require ICU admission postoperatively, and most are discharged either the same day or the following morning. The result is a minimally-morbid diagnostic and treatment option for patients with previously-treated intracranial tumors. Here, we offer an illustrative case and brief review of LITT application in the setting of AIRS. Citation Case ReportThe patient is a 66 year old right-handed female with a history of lung adenocarcinoma, initially diagnosed in January of 2014 when she presented with cough and hemoptysis. Surveillance imaging demonstrated a solitary 1cm metastasis of the right frontal lobe, and the patient was treated with Cyber Knife on 3/5/2014. She underwent concurrent chemoradiation with carboplatin/paclitaxel and 60Gy radiation to the right upper lung, mediastinum and SCV region (completed 4/16/2014), followed by an additional two cycles of chemotherapy (completed 5/20/2014). She was subsequently placed on erlotinib due to EGFR mutation, then switched to afatenib in September 2014.In July 2015 the patient noted a sense of imbalance and left hand weakness; an MRI demonstrated enlargement of the previously-treated brain metastasis at the posterior margin of the right superior frontal gyrus, with significant associated edema (Figure 1). She was started on dexamethasone, with some symptomatic improvement. Given her continued weakness, however, a plan was made for the patient to undergo stereotactic biopsy with possible subsequent LITT.On 10/12/2015 the patient was electively taken to the operating room. Using frameless stereotaxy, a biopsy was...

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“…11,13,21,22 The minimally invasive nature of LITT coupled with advances in MR thermography techniques has led to the exploration of this technique's use for various neurosurgical indications such as deep-seated glioma, 8,9,20,22 brain metastasis, 2,5,21 radiation necrosis, 4,16,21 and epilepsy. 7,23 LITT has shown promising results in the management of patients with difficult-toaccess brain tumors 12 and has emerged as a potential tool in the armamentarium of neurosurgeons.…”

Section: Neurosurg Focus 41 (4):e6 2016mentioning

confidence: 99%

“…The anchoring bolt (outer diameter 4.5 mm) was placed using the VarioGuide along the stereotactic trajectory. After placement of the bolt, the VarioGuide was removed, and a pulsed diode laser probe (side firing/diffuse tip; Nd:YAG [neodymium-doped yttrium aluminum garnet] range 1046 nm with an output of 12 W) 11 was introduced into the bolt after measuring the length of the laser probe required and locking at the corresponding length. The laser probe was then connected to the robotic probe drive, and the MRI coil was placed over the bolt (in a sterile manner) at the desired location for scanning.…”

Section: Surgical Techniquementioning

confidence: 99%

Thermal injury to corticospinal tracts and postoperative motor deficits after laser interstitial thermal therapy

Sharma

Habboub

Behbahani

et al. 2016

FOC

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OBJECTIVE Laser interstitial thermal therapy (LITT) has been increasingly used to treat deep-seated tumors. Despite its being minimally invasive, there is a risk of LITT damaging adjacent critical structures, including corticospinal tracts (CSTs). In this study, the authors investigated the predictive value of overlap between the hyperthermic field and CSTs in determining postoperative motor deficit (PMDs). METHODS More than 140 patients underwent an LITT procedure in our institution between April 2011 and June 2015. Because of the tumor's proximity to critical structures, 80 of them underwent preoperative diffusion tensor imaging and were included in this study. Extent of the hyperthermic field was delineated by the software as thermal-damage-threshold (TDT) lines (yellow [43°C for 2 minutes], blue [43°C for 10 minutes], and white [43°C for 60 minutes]). The maximum volume and the surface area of overlaps between motor fibers and the TDT lines were calculated and compared with the PMDs. RESULTS High-grade glioma (n = 46) was the most common indication for LITT. Postoperative motor deficits (partial or complete) were seen in 14 patients (11 with permanent and 3 with temporary PMDs). The median overlap volumes between CSTs with yellow, blue, and white TDT lines in patients with any PMD (temporary or permanent) were 1.15, 0.68, and 0.41 cm3, respectively. The overlap volumes and surface areas revealed significant differences in those with PMDs and those with no deficits (p = 0.0019 and 0.003, 0.012 and 0.0012, and 0.001 and 0.005 for the yellow, blue, and white TDT lines, respectively). The receiver operating characteristic was used to select the optimal cutoff point of the overlapped volumes and areas. Cutoff points for overlap volumes and areas based on optimal sensitivity (92%–100%) and specificity (80%–90%) were 0.103, 0.068, and 0.046 cm3 and 0.15, 0.07, and 0.11 mm2 for the yellow, blue, and white TDT lines, respectively. CONCLUSIONS Even a minimal overlap between the TDT lines and CSTs can cause a PMD after LITT. Precise planning and avoidance of critical structures and important white matter fibers should be considered when treating deep-seated tumors.

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Renaissance of laser interstitial thermal ablation

Cited by 162 publications

References 55 publications

Emerging surgical therapies in the treatment of pediatric epilepsy

Emerging surgical therapies in the treatment of pediatric epilepsy

Laser Interstitial Thermal Therapy for Radiation Necrosis/Adverse Inflammatory Responses to SRS - Case Report and Literature Review

Thermal injury to corticospinal tracts and postoperative motor deficits after laser interstitial thermal therapy

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