Laser interstitial thermal therapy (LITT) for pediatric patients affected by intracranial tumors

Abstract

IntroductionThe surgical treatment of brain tumors has evolved over time, offering different strategies tailored to patients and their specific lesions. Among these strategies, Laser Interstitial Thermal Therapy (LITT) is one of the most recent advances in pediatric neurooncological surgery, and its results and evolution are still under assessment.MethodsWe retrospectively analyzed data from six pediatric patients with deep-seated brain tumors treated with LITT at a single center between November 2019 and June 2022. A total of four patients underwent a stereotaxic biopsy during the same operating session. The indications and preparation for LITT, technical issues, clinical and radiological follow-up, impact on quality of life, and oncological treatment are discussed.ResultsThe mean patient age eight years (ranging from 2 to 11 years). The lesion was thalamic in four patients, thalamo-peduncular in one, and occipital posterior periventricular in one. In total, two patients had been previously diagnosed with low-grade glioma (LGG). Biopsies revealed LGG in two patients, ganglioglioma grade I in one, and diffuse high-grade glioma (HGG) in one. Postoperatively, two patients presented with transient motor deficits. The mean follow-up period was 17 months (ranging from 5 to 32 months). Radiological follow-up showed a progressive reduction of the tumor in patients with LGG.ConclusionLaser interstitial thermal therapy is a promising, minimally invasive treatment for deep-seated tumors in children. The results of lesion reduction appear to be relevant in LGGs and continue over time. It can be used as an alternative treatment for tumors located at sites that are difficult to access surgically or where other standard treatment options have failed.

Meta‐analysis of the impact of laser interstitial hyperthermia on wound healing complications in brain tumors

“…Moreover, the comparatively smaller sample sizes and varied patient demographics in different studies could have impacted the observed heterogeneity and effect sizes. These limitations have been reported in multiple studies, emphasizing the critical need for more extensive, well‐designed studies incorporating control groups to provide more conclusive insights into the intricate relationship between LITT and wound complications in brain tumour patients 32–35 …”

Laser Interstitial Thermal Therapy (LITT) for Pediatric Low-Grade Glioma – Case Presentations And Lessons Learned

“…Laser interstitial thermal therapy (LITT) is a neurosurgical technique that is becoming increasingly popular in the pediatric population 2,3 . PLGGs commonly involve deep and eloquent regions; such as thalamic or thalamo-peduncular, periventricular, and other subcortical locations.…”

“…Most of the current literature on LITT for brain tumors focuses on high-grade gliomas and brain metastases in adults, as well as for radiation necrosis following their treatment. The evidence for the use of LITT in low-grade gliomas (LGGs), especially in the pediatric population, is still evolving 3 . In pediatrics, LITT has been used to treat a variety of pathologies, including hypothalamic hamartomas, pilocytic astrocytomas, and subependymal giant cell astrocytomas, among others 2 .…”

Laser interstitial thermal therapy as a radiation-sparing approach for central nervous system tumors in children with cancer predisposition syndromes: report of a child with Li-Fraumeni syndrome. Illustrative case

“… 22–26 The low-grade characteristics of our patient’s tumor also portended a high probability of long-term success, given other reports in the literature suggesting optimal efficacy of LITT for children with low-grade rather than high-grade gliomas. 29 Although not extensively studied in superficial tumors, LITT is generally reserved for tumors with deep-seated origins, including thalamic, peduncular, and periventricular locations, offering substantial reductions in morbidity and mortality risks over open surgery. 29 Thus, the low-grade tumor characteristics and periventricular location of our patient’s tumor favored intervention with LITT over craniotomy and microdissection.…”

“… 29 Although not extensively studied in superficial tumors, LITT is generally reserved for tumors with deep-seated origins, including thalamic, peduncular, and periventricular locations, offering substantial reductions in morbidity and mortality risks over open surgery. 29 Thus, the low-grade tumor characteristics and periventricular location of our patient’s tumor favored intervention with LITT over craniotomy and microdissection.…”