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

Abstract

mas, metastases, epilepsy foci, and radionecrosis. The rate of complications/unexpected readmission was 6.0%, and the mortality rate was 2.2%. With high-grade tumors, tumor volumes >3 cm in diameter trended toward a higher rate of complication (p = 0.056). Median progression-free survival (PFS) and overall survival (OS) for recurrent GBM were 7.4 and 11.6 months, respectively. As a frontline treatment for newly diagnosed GBM, median PFS and OS were 5.9 and 11.4 months, respectively. For metastases, median PFS was not yet reached, and OS was 17.2 months. Conclusion: Our series suggests that ILA is a safe and efficacious treatment for a variety of intracranial pathologies, can be tailored to treat difficult-to-access lesions, and may offer a novel alternative to open craniotomy in properly selected patients. Abstract Background: Managing difficult-to-access lesions or surgically accessible lesions in fragile patients is a central problem in neurosurgery. MRI-guided interstitial laser ablation (ILA) is a minimally invasive option that may provide a safe means of treating these challenging patients. Objective: We aim to (1) evaluate safety, efficacy, and preliminary outcomes within a diverse and large series of ILA treatments; and (2) report technical details and operative trends that proved useful over time in the authors' experience and that may be of use to neurosurgeons who perform ILA. Methods: A retrospective evaluation of ILA patients was performed in terms of demographics, surgical techniques, and clinical outcomes. Results: A total of 133 intracranial lesions in 120 patients were treated with ILA, including glioblastomas (GBM), other glio-

Inverse national trends of laser interstitial thermal therapy and open surgical procedures for refractory epilepsy: a Nationwide Inpatient Sample–based propensity score matching analysis

“…The National Association of Epilepsy Centers annual surveys (2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012) reported that use of ATL for TLE decreased by more than 65% between 2006 and 2012 and extratemporal lobe surgeries comprised 38% of all resective surgeries in 2012. 17 Laser interstitial thermal therapy (LITT) is a minimally invasive surgical technique that has shown favorable outcomes in patients with a variety of brain lesions 16,18,26,27,[32][33][34] and has shown favorable outcomes in patients with epilepsy. 1,19,20,35,37,40 Following FDA clearance of two major LITT systems in 2007 (Visualase System, Medtronic Inc.) and 2009 (NeuroBlate System, Monteris Medical Corp.), this technology was first used to treat mesial TLE (mTLE) in 2010 and has been rapidly adapted as one of the neurosurgical tools to manage patients with RE.…”

Ablation dynamics during laser interstitial thermal therapy for mesiotemporal epilepsy

“…Tissues at the periphery of the target or with high ablation thresholds may require unique trajectories or ablation parameters. Alternatively, a second laser catheter may be necessary [ 1 , 15 ]. By estimating tissue thermal responses a priori from preoperative imaging, it should be possible to improve outcomes by reducing frequency of missed ablations.…”

“…In addition, availability of normative cross-patient thermoablative properties would put us one step closer to being able to safely offer LITT without the need for real-time MRI monitoring of the ablation. In well-selected patients this could significantly decrease procedure duration without sacrificing safety, thereby reducing patient discomfort and risks of anesthesia and freeing up valuable hospital resources [ 15 , 33 ].…”

“…For example, given tissue inhomogeneities, heat may spread asymmetrically leading to inadequate ablation or increased threat to nearby functional tissues [ 11 , 13 , 14 ]. This may result in treatment failure or require return from the MRI suite to the operating room for laser repositioning [ 1 , 15 , 16 ]. Variability in tissue thermoablative properties is supported by animal and simulation studies, which suggest that tissues ablate differently depending on pathology and influences of local anatomy, such as the presence of nearby blood vessels or CSF spaces [ 10 – 12 , 17 – 19 ].…”

Management of Intracranial Metastatic Disease With Laser Interstitial Thermal Therapy

“…The development of complementary technologies, such as intraoperative magnetic resonance imaging (MRI) and real-time MRI thermometry has enabled LITT to enter the fields of neurosurgery and neuro-oncology ( 5 – 10 ). In recent years, LITT has been applied to intracranial lesions, including metastatic disease to the brain, and has yielded safe and satisfactory treatment results with significantly less morbidity ( 11 ) and shorter hospital stays than traditional open craniotomy ( 7 ).…”