Magnetic Resonance Imaging-Guided Focused Laser Interstitial Thermal Therapy for Intracranial Lesions

Hawasli, Ammar H.; Bagade, Swapnil; Shimony, Joshua S.; Miller‐Thomas, Michelle M.; Leuthardt, Eric C.

doi:10.1227/neu.0000000000000144

Cited by 188 publications

(163 citation statements)

References 23 publications

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“…Realtime MR thermometry depicts tissue heating and suggests spatial localization of coagulation zones as the treatment is performed, allowing for tailored therapy with adaptations to results during one treatment session. Early reports of MRg-LITT have indicated preliminary safety and efficacy in the treatment of recurrent primary and metastatic tumors, 2,8,9,19,23 mesial temporal lobe epilepsy, 27 and other epileptic foci 3,8 including HHs and periventricular nodular heterotopias. 5,26 Furthermore, MRg-LITT may offer the possibility of another less invasive option for epilepsy surgery and in this case will significantly limit approachrelated morbidity.…”

Section: 20mentioning

confidence: 99%

Magnetic resonance imaging–guided laser interstitial thermal therapy for previously treated hypothalamic hamartomas

Burrows¹,

Marsh²,

Worrell

et al. 2016

FOC

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OBJECTIVE Hypothalamic hamartomas (HHs) are associated with gelastic seizures and the development of medically refractory epilepsy. Magnetic resonance imaging–guided laser interstitial thermal therapy (MRg-LITT) is a minimally invasive ablative treatment that may have applicability for these deep-seated lesions. Here, the authors describe 3 patients with refractory HHs who they treated with MRg-LITT. METHODS An institutional review board–approved prospective database of patients undergoing Visualase MRg-LITT was retrospectively reviewed. Demographic and historical medical data, including seizure and medication histories, previous surgeries, procedural details, and surgical complications, along with radiological interpretation of the HHs, were recorded. The primary outcome was seizure freedom, and secondary outcomes included medication reduction, seizure frequency, operative morbidity, and clinical outcome at the latest follow-up. RESULTS All 3 patients in the multi-institutional database had developed gelastic seizures related to HH at the ages of 7, 7, and 9 years. They presented for further treatment at 25, 28, and 48 years of age, after previous treatments with stereotactic radiosurgery in all cases and partial hamartoma resection in one case. One ablation was complicated by a small tract hemorrhage, which was stable on postoperative imaging. One patient developed hyponatremia and experienced weight gain, which were respectively managed with fluid restriction and counseling. At the most recent follow-up at a mean of 21 months (range 1–32 months), one patient was seizure free while another had meaningful seizure reduction. Medication was reduced in one case. CONCLUSIONS Adults with gelastic seizures despite previous treatments can undergo MRg-LITT with reasonable safety and efficacy. This novel therapy may provide a minimally invasive alternative for primary and recurrent HH as the technique is refined.

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Section: 20mentioning

confidence: 99%

Magnetic resonance imaging–guided laser interstitial thermal therapy for previously treated hypothalamic hamartomas

Burrows¹,

Marsh²,

Worrell

et al. 2016

FOC

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“…Initially developed as an alternative to surgery, LITT offers minimally-invasive cytoreduction in patients with significant comorbidities or difficult-to-access intracranial lesions [23]. Initial results have shown the feasibility of LITT for a variety of intracranial pathologies, including new and recurrent metastatic tumors [15,24,25], post-treatment edema [26], radiation necrosis [27], epileptogenic foci [28], and primary brain tumors such as glioblastoma [29]. Briefly, a neurosurgeon uses a stereotacticallyguided laser to apply low-voltage energy to an intracranial lesion, generating hyperthermia; the process is guided with real-time MRI thermography in a manner that enables the surgeon to direct heat application across the lesion volume, resulting in controlled cell death [30].…”

Section: Introductionmentioning

confidence: 99%

Laser Interstitial Thermal Therapy for Radiation Necrosis/Adverse Inflammatory Responses to SRS - Case Report and Literature Review

Tsvankin¹,

Howell²,

Fecci³

2017

JNSK

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Brain metastases are the most common type of intracranial tumor, and confer a dismal prognosis. Morbidity in these patients arises not only from tumor burden but from treatment-related toxicities. Among the most significant of these is radiation necrosis, a common sequelae of stereotactic radiosurgery that may cause neurologic impairment through mass effect or steroid-refractory edema. Truly, "radiation necrosis" is a misnomer, as the process is more accurately an adverse inflammatory response post-stereotactic radiotherapy (AIRS). Because it is impossible to reliably distinguish AIRS from tumor recurrence without a biopsy, and because high-dose steroids are poorly tolerated, management of AIRS poses a significant therapeutic challenge. Laser interstitial thermal therapy (LITT) is an emerging minimally-invasive treatment modality which uses hyperthermia to ablate intracranial pathologic tissues. Here, we describe the use of LITT in a patient with steroid-refractory AIRS following radiosurgery for a right supplementary motor area metastatic focus, and provide a brief review of the utility of LITT in patients with AIRS. direct heat application across the lesion volume, resulting in controlled cell death [30]. In contrast to open surgery, LITT can be performed through the same basic operating platform as a biopsy, allowing the neurosurgeon to avoid the risk of performing a craniotomy. The incision is less than 1cm long; at our institution, patients do not require ICU admission postoperatively, and most are discharged either the same day or the following morning. The result is a minimally-morbid diagnostic and treatment option for patients with previously-treated intracranial tumors. Here, we offer an illustrative case and brief review of LITT application in the setting of AIRS. Citation Case ReportThe patient is a 66 year old right-handed female with a history of lung adenocarcinoma, initially diagnosed in January of 2014 when she presented with cough and hemoptysis. Surveillance imaging demonstrated a solitary 1cm metastasis of the right frontal lobe, and the patient was treated with Cyber Knife on 3/5/2014. She underwent concurrent chemoradiation with carboplatin/paclitaxel and 60Gy radiation to the right upper lung, mediastinum and SCV region (completed 4/16/2014), followed by an additional two cycles of chemotherapy (completed 5/20/2014). She was subsequently placed on erlotinib due to EGFR mutation, then switched to afatenib in September 2014.In July 2015 the patient noted a sense of imbalance and left hand weakness; an MRI demonstrated enlargement of the previously-treated brain metastasis at the posterior margin of the right superior frontal gyrus, with significant associated edema (Figure 1). She was started on dexamethasone, with some symptomatic improvement. Given her continued weakness, however, a plan was made for the patient to undergo stereotactic biopsy with possible subsequent LITT.On 10/12/2015 the patient was electively taken to the operating room. Using frameless stereotaxy, a biopsy was...

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“…stereotactic laser ablation of high-grade gliomas TO THE EDITOR: We read with great interest the paper on laser-induced thermal therapy for high-grade gliomas by Hawasli et al 1 (Hawasli AH, Kim AH, Dunn GP, et al: Stereotactic laser ablation of high-grade gliomas. Neurosurg Focus 37(6):E1, December 2014).…”

mentioning

confidence: 99%

“…Furthermore, this therapy proves promising; LITT has been associated with an overall survival ranging from 6.9 to 30 months for high-grade gliomas. 1,2 LITT is viewed as a cytoreductive technique because the effects of therapy are immediate, as opposed to radiosurgery, in which the effects may take several weeks to occur. 1 High temperature (> 70°C) induces cellular necrosis and apoptosis with peritumoral blood-brain barrier (BBB) disruption (> 40°C).…”

mentioning

confidence: 99%

Letter to the Editor: Stereotactic laser ablation of high-grade gliomas

Smith¹,

Salacz²,

Camarata³

2015

FOC

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Magnetic Resonance Imaging-Guided Focused Laser Interstitial Thermal Therapy for Intracranial Lesions

Cited by 188 publications

References 23 publications

Magnetic resonance imaging–guided laser interstitial thermal therapy for previously treated hypothalamic hamartomas

Magnetic resonance imaging–guided laser interstitial thermal therapy for previously treated hypothalamic hamartomas

Laser Interstitial Thermal Therapy for Radiation Necrosis/Adverse Inflammatory Responses to SRS - Case Report and Literature Review

Letter to the Editor: Stereotactic laser ablation of high-grade gliomas

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