Intracerebral laser interstitial thermal therapy followed by tumor resection to minimize cerebral edema

Abstract

<jats:sec> <jats:title>OBJECTIVE</jats:title> <jats:p>Laser interstitial thermal therapy (LITT) is used in numerous neurosurgical applications including lesions that are difficult to resect. Its rising popularity can be attributed to its minimally invasive approach, improved accuracy with real-time MRI guidance and thermography, and enhanced control of the laser. One of its drawbacks is the possible development of significant edema, which contributes to extended hospital stays and often necessitates hyperosmolar or steroid therapy. Here, the authors discuss the use of minimally invasive craniotomy to resect tissue ablated with LITT in attempt to minimize cerebral edema.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>Five patients with glioblastoma multiforme prospectively underwent LITT followed by resection. The LITT was performed with the aid of an MR-compatible skull-mounted frame in the MRI suite. Ablated tumor was then resected via small craniotomy by using the NICO Myriad system or cavitron ultrasonic surgical aspirator. Postoperative management involved dexamethasone administration slowly tapered over several weeks.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>The use of resection following LITT, as compared with open resection or LITT alone, did not extend the hospital stay except in 1 patient who required 3-day inpatient management of edema with a trapped ventricle. No new neurological deficits were encountered, although 1 patient developed seizures postoperatively. No increase in infection rates was identified.</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>Resection of ablated tumor is a viable option to reduce the incidence of neurological deficits due to edema following LITT. This approach appears to mitigate cerebral edema by increasing available volume for mass effect and reducing the tissue burden that may promote an inflammatory response.</jats:p></jats:sec>

MRI-Guided Interstitial Laser Ablation for Intracranial Lesions: A Large Single-Institution Experience of 133 Cases

“…While we do not propose precluding larger lesions, it is important to counsel patients that the procedure may be associated with a longer operative time, longer hospital stay, and a higher risk for a surgical complication. These larger lesions may merit additional minimally invasive debulking, as has been previously described [13,14]. With regard to clinical outcome, there were several diagnoses that had sufficient clinical numbers for which more objective observations could be made.…”

Glioblastoma Treated With Magnetic Resonance Imaging-Guided Laser Interstitial Thermal Therapy: Safety, Efficacy, and Outcomes

“…It is postulated that patients with larger tumor volume are predisposed to complications from cerebral edema and mass effect. 20 , 21 Intuitively, it would seem that larger volume ablations would result in more cell death, coagulative necrosis, and release of more inflammatory mediators than smaller volume ablations. In our series, mean tumor volume in patients who had complications was 15.5 cm 3 while that of uncomplicated cases was 11.7 cm 3 ; however, this did not reach significance ( P = 0.20).…”

Management of Intracranial Metastatic Disease With Laser Interstitial Thermal Therapy

“…Post-LITT edema may potentially be more fulminant than post-craniotomy edema due to the lack of any decompression with LITT alone. A prolonged steroid course (2–3 weeks) or a minimally invasive craniotomy and limited resection immediately following LITT of larger tumors may represent strategies to mitigate this phenomenon ( 20 , 21 ).…”