2019
DOI: 10.3171/2018.7.jns18886
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Ablation dynamics of subsequent thermal doses delivered to previously heat-damaged tissue during magnetic resonance–guided laser-induced thermal therapy

Abstract: OBJECTIVEIntraoperative dynamics of magnetic resonance–guided laser-induced thermal therapy (MRgLITT) have been previously characterized for ablations of naive tissue. However, most treatment sessions require the delivery of multiple doses, and little is known about the ablation dynamics when additional doses are applied to heat-damaged tissue. This study investigated the differences in ablation dynamics between naive versus damaged tissue.METHODSThe authors examined 168 ablations from 60 patients across vario… Show more

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Cited by 10 publications
(4 citation statements)
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“…LITT can therefore represent the first choice procedure in these cases, given that: (i) it is performed in stereotactic conditions through a 3.2 mm burr hole, with an entry point that can be chosen according to preoperative MRI and DSA to avoid any vessel; (ii) a stereotactic needle biopsy can be performed during the same procedure, providing further treatment possibilities according to the molecular profile if required; (iii) it is performed under real-time MR imaging, allowing simulation of the ablation volume and tailoring of the therapy; (iv) it can be repeated along the same or another trajectory in case of relapse. Provided that the lesion conformation is favorable (a round or elliptic shape), LITT may achieve satisfactory ablation volumes ( 22 ) and assure sustained control of the tumor ( 4 , 5 ): this is particularly attractive in NF1 patients to reduce the need for radiation and prolonged medical treatment, recognizing that the use of radiotherapy is not recommended ( 20 , 21 , 23 ). The choice of whether or not to perform a stereotactic needle biopsy before the introduction of the laser fiber is still under discussion, as it has been pointed out that this could cause MRI artifacts at the biopsy site, resulting in sub-optimal MR thermometry and potentially decreased LITT efficacy ( 24 , 25 ).…”
Section: Discussionmentioning
confidence: 99%
“…LITT can therefore represent the first choice procedure in these cases, given that: (i) it is performed in stereotactic conditions through a 3.2 mm burr hole, with an entry point that can be chosen according to preoperative MRI and DSA to avoid any vessel; (ii) a stereotactic needle biopsy can be performed during the same procedure, providing further treatment possibilities according to the molecular profile if required; (iii) it is performed under real-time MR imaging, allowing simulation of the ablation volume and tailoring of the therapy; (iv) it can be repeated along the same or another trajectory in case of relapse. Provided that the lesion conformation is favorable (a round or elliptic shape), LITT may achieve satisfactory ablation volumes ( 22 ) and assure sustained control of the tumor ( 4 , 5 ): this is particularly attractive in NF1 patients to reduce the need for radiation and prolonged medical treatment, recognizing that the use of radiotherapy is not recommended ( 20 , 21 , 23 ). The choice of whether or not to perform a stereotactic needle biopsy before the introduction of the laser fiber is still under discussion, as it has been pointed out that this could cause MRI artifacts at the biopsy site, resulting in sub-optimal MR thermometry and potentially decreased LITT efficacy ( 24 , 25 ).…”
Section: Discussionmentioning
confidence: 99%
“…Laser interstitial thermal therapy (LITT), a minimally invasive stereotactic treatment option, first introduced in 1983, is emerging as a viable treatment option for deep-seated primary and metastatic brain lesions due to the use of real-time magnetic resonance (MR) thermography [ 2 ]. The therapy involves the insertion of a laser catheter, which is subsequently heated to destroy pathologic tissue [ 3 ]. Real-time MR guidance focuses the laser treatment to decrease damage to surrounding structures [ 4 ].…”
Section: Introductionmentioning
confidence: 99%
“…[15][16][17] However, analyses of laser thermal dynamics in a single TDE cross-section limit understanding of ablation that, in reality, crosses multiple planes. 11,13,14,18 Currently, it is not feasible to generate intraoperative thermal mapping across all MRI scans encompassing the target site due to software limitations. Thus, in order to provide 3-dimensional characterization of the present TDE data, we investigated whether volumetric data could be acquired by the 2-dimensional information generated from the Visualase thermal software (Medtronic Inc, Dublin, Ireland).…”
Section: Introductionmentioning
confidence: 99%
“…Advancements in MRgLITT have correlated TDE cross‐sectional area growth to multiple laser parameters (ie, power, duration, and repeated doses 11–13 ) and postoperative MRI ablative areas, 14 along with recent initiatives utilizing preoperative imaging and procedural factors to predict TDE distribution 15–17 . However, analyses of laser thermal dynamics in a single TDE cross‐section limit understanding of ablation that, in reality, crosses multiple planes 11,13,14,18 . Currently, it is not feasible to generate intraoperative thermal mapping across all MRI scans encompassing the target site due to software limitations.…”
Section: Introductionmentioning
confidence: 99%