Treatment of a supratentorial primitive neuroectodermal tumor using magnetic resonance–guided laser-induced thermal therapy

Abstract

<jats:p>Supratentorial primitive neuroectodermal tumors (PNETs) are rare tumors that carry a poorer prognosis than those arising from the infratentorial compartment (such as medulloblastoma). The overall prognosis for these patients depends on several factors including the extent of resection, age at diagnosis, CSF dissemination, and site in the supratentorial space. The authors present the first case of a patient with a newly diagnosed supratentorial PNET in which cytoreduction was achieved with MR-guided laser-induced thermal therapy. A 10-year-old girl presented with left-sided facial weakness and a large right thalamic mass extending into the right midbrain. The diagnosis of supratentorial PNET was made after stereotactic biopsy. Therapeutic options for this lesion were limited because of the risks of postoperative neurological deficits with resection. The patient underwent MR-guided laser-induced thermal ablation of her tumor. Under real-time MR thermometry, thermal energy was delivered to the tumor at a core temperature of 90°C for a total of 960 seconds. The patient underwent follow-up MR imaging at regular intervals to evaluate the tumor response to the thermal ablation procedure. Initial postoperative scans showed an increase in the size of the lesion as well as the amount of the associated edema. Both the size of the lesion and the edema stabilized by 1 week and then decreased below preablation levels at the 3-month postsurgical follow-up. There was a slight increase in the size of the lesion and associated edema at the 6-month follow-up scan, presumably due to concomitant radiation she received as part of her postoperative care. The patient tolerated the procedure well and has had resolution of her symptoms since surgery. Further study is needed to assess the role of laser-induced thermal therapy for the treatment of intracranial tumors. As such, it is a promising tool in the neurosurgical armamentarium. Postoperative imaging has shown no evidence of definitive recurrence at the 6-month follow-up period, but longer-term follow-up is required to assess for late recurrence.</jats:p>

Magnetic resonance–guided laser interstitial thermal therapy: report of a series of pediatric brain tumors

“…6,25,34 The system was designed to simultaneously control ablation and generate color-coded temperature maps, which are overlaid on MR images. 13,22,34 An irreversible damage zone is calculated based on time and temperature data from individual voxels in the treatment area 18 and subsequent cellular death. 39 To date, based on this initial experience, we do not have enough data to specify the different time/temperature ratios that are adequate for the various types of tissue and brain tumors.…”

Automatic selection of localized region-based active contour models using image content analysis applied to brain tumor segmentation

“…As in Refs. [31,32], for distinguishing structures based on their forms, the present approach considers that tumors have in general an ellipsoidal shape compared to …”

MRI-guided laser interstitial thermal therapy of intracranial tumors and epilepsy: State-of-the-art review and a case study from pediatrics

“…So far in the literature, laser interstitial thermal therapy (LITT) has been described to treat brain metastases [1,2], primary neoplasia [3][4][5][6][7], and radiation-induced necrosis [8] with an excellent safety profile. LITT has also been used as a minimally invasive alternative to surgical treatment of refractory epilepsy [9,10] for ablating single epileptogenic foci, such as tumors, hypothalamic hamartomas, cortical dysplasia and mesial temporal sclerosis [9].…”