Association of intraoperative end-tidal carbon dioxide level with ablation volume during magnetic resonance–guided laser interstitial thermal therapy for mesial temporal lobe epilepsy

Hwang, Brian Y.; Eremiev, Alexander; Palla, Adhith; Mampre, David; Negoita, Serban; Tsehay, Yohannes; Kim, Min Jae; Coogan, Christopher; Kang, Joon Y.; Anderson, William S.

doi:10.3171/2021.9.jns211554

Cited by 3 publications

(2 citation statements)

References 37 publications

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“…Greater understanding of MRgLITT-specific laser thermodynamics in the brain and associated modifiable factors may also aid in improving predictability of ablation volume, ablation precision, and ultimately long-term seizure outcome in mTLE. 37…”

Section: Discussionmentioning

confidence: 99%

Piriform Cortex Ablation Volume Is Associated With Seizure Outcome in Mesial Temporal Lobe Epilepsy

et al. 2022

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BACKGROUND: Growing evidence suggests that piriform cortex resection during anterior temporal lobectomy is important for achieving good seizure outcome in mesial temporal lobe epilepsy (mTLE). However, the relationship between seizure outcome and piriform cortex ablation during MR-guided laser interstitial thermal therapy (MRgLITT) remains unclear. OBJECTIVE: To determine whether ablation of piriform cortex was associated with seizure outcome in patients with mTLE undergoing MRgLITT. METHODS: We performed preablation and postablation volumetric analyses of hippocampus, amygdala, piriform cortex, and ablation volumes in patients with mTLE who underwent MRgLITT at our institution from 2014 to 2019. RESULTS: Thirty nine patients with mTLE were analyzed. In univariate logistic regression, percent piriform cortex ablation was associated with International League Against Epilepsy (ILAE) class 1 at 6 months (odds ratio [OR] 1.051, 95% CI [1.001-1.117], P = .045), whereas ablation volume, percent amygdala ablation, and percent hippocampus ablation were not (P > .05). At 1 year, ablation volume was associated with ILAE class 1 (OR 1.608, 95% CI [1.071-2.571], P = .021) while percent piriform cortex ablation became a trend (OR 1.050, 95% CI [0.994-1.109], P = .054), and both percent hippocampus ablation and percent amygdala ablation were not significantly associated with ILAE class 1 (P > .05). In multivariable logistic regression, only percent piriform cortex ablation was a significant predictor of seizure freedom at 6 months (OR 1.085,], P = .019) and at 1 year (OR 1.074, 95% CI [1.003-1.178], P = .041). CONCLUSION: Piriform cortex ablation volume is associated with seizure outcome in patients with mTLE undergoing MRgLITT. The piriform cortex should be considered a high yield ablation target to achieve good seizure outcome.

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Section: Discussionmentioning

confidence: 99%

Piriform Cortex Ablation Volume Is Associated With Seizure Outcome in Mesial Temporal Lobe Epilepsy

et al. 2022

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“…Even with artery-preserving strategies, vasospasm and ischemic events may still occur during open resection for deep-seated tumors [8,[17][18][19] . Although the presence of CSF spaces and large blood vessels are known to act as heat sinks for thermal spread during LITT, it has been unclear whether peritumor microvasculature would be able to safely tolerate ablation [7,10,11,20,21] . Our study is the rst to report that perforating vasculature can safely be preserved when ablating deep-seated tumors within the basal ganglia, thalamus, insula, and anterior perforated substance.…”

Section: Discussionmentioning

confidence: 99%

Laser interstitial thermal therapy for deep-seated perivascular brain tumors is not associated with distal ischemia

Reese,

Fadel,

Pawloski

et al. 2024

J Neurooncol

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Laser interstitial thermal therapy (LITT) is a minimally invasive cytoreductive treatment option for brain tumors with a risk of vascular injury from catheter placement or thermal energy. This may be of concern with deep-seated tumors that have surrounding end-artery perforators and critical microvasculature. The purpose of this study was to assess the risk of distal ischemia following LITT for deep-seated perivascular brain tumors. MethodsA retrospective review of a multi-institution database was used to identify patients who underwent LITT between 2013-2022 for tumors located within the insula, thalamus, basal ganglia, and anterior perforated substance. Demographic, clinical and volumetric tumor characteristics were collected. The primary outcome was radiographic evidence of distal ischemia on post-ablation magnetic resonance imaging (MRI). Results61 LITT ablations for deep-seated perivascular brain tumors were performed. Of the tumors treated, 24 (39%) were low-grade gliomas, 32 (52%) were high-grade gliomas, and 5 (8%) were metastatic. The principal location included 31 (51%) insular, 14 (23%) thalamic, 13 (21%) basal ganglia, and 3 (5%)anterior perforated substance tumors. The average tumor size was 19.6 cm 3 with a mean ablation volume of 11.1 cm 3 . The median extent of ablation was 92% (IQR 30%, 100%). Two patients developed symptomatic intracerebral hemorrhage after LITT. No patient had radiographic evidence of distal ischemia on post-operative diffusion weighted imaging. ConclusionWe demonstrate that LITT for deep-seated perivascular brain tumors has minimal ischemic risks and is a safe cytoreductive treatment option for otherwise di cult to access intracranial tumors.

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Laser Interstitial Thermal Therapy for Deep-seated Perivascular Brain Tumors is Not Associated with Distal Ischemia

Reese

Fadel

Pawloski

et al. 2023

Preprint

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Purpose Laser interstitial thermal therapy (LITT) is a minimally invasive cytoreductive treatment option for brain tumors with a risk of vascular injury from catheter placement or thermal energy. This may be of concern with deep-seated tumors that have surrounding end-artery perforators and critical microvasculature. The purpose of this study was to assess the risk of distal ischemia following LITT for deep-seated perivascular brain tumors. Methods A retrospective review of a multi-institution database was used to identify patients who underwent LITT between 2013–2022 for tumors located within the insula, thalamus, basal ganglia, and anterior perforated substance. Demographic, clinical and volumetric tumor characteristics were collected. The primary outcome was radiographic evidence of distal ischemia on post-ablation magnetic resonance imaging (MRI). Results 61 LITT ablations for deep-seated perivascular brain tumors were performed. Of the tumors treated, 24 (39%) were low-grade gliomas, 32 (52%) were high-grade gliomas, and 5 (8%) were metastatic. The principal location included 31 (51%) insular, 14 (23%) thalamic, 13 (21%) basal ganglia, and 3 (5%) anterior perforated substance tumors. The average tumor size was 19.6 cm3 with a mean ablation volume of 11.1 cm3. The median extent of ablation was 92% (IQR 30%, 100%). Two patients developed symptomatic intracerebral hemorrhage after LITT. No patient had radiographic evidence of distal ischemia on post-operative diffusion weighted imaging. Conclusion We demonstrate that LITT for deep-seated perivascular brain tumors has minimal ischemic risks and is a safe cytoreductive treatment option for otherwise difficult to access intracranial tumors.

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Association of intraoperative end-tidal carbon dioxide level with ablation volume during magnetic resonance–guided laser interstitial thermal therapy for mesial temporal lobe epilepsy

Cited by 3 publications

References 37 publications

Piriform Cortex Ablation Volume Is Associated With Seizure Outcome in Mesial Temporal Lobe Epilepsy

Piriform Cortex Ablation Volume Is Associated With Seizure Outcome in Mesial Temporal Lobe Epilepsy

Laser interstitial thermal therapy for deep-seated perivascular brain tumors is not associated with distal ischemia

Laser Interstitial Thermal Therapy for Deep-seated Perivascular Brain Tumors is Not Associated with Distal Ischemia

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