MRI-Guided Laser-Induced Interstitial Thermotherapy of Cerebral Neoplasms

Kahn, Thomas; Bettag, Martin; Frank, Ulrich; Schwarzmaier, Hans‐Joachim; Schober, R.; Fürst, G.; Mödder, Ulrich

doi:10.1097/00004728-199407000-00002

Cited by 256 publications

(139 citation statements)

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“…Laser-induced interstitial thermotherapy (LITT) is a relatively new treatment modality for the thermal destruction (coagulation) of solid tumors (1)(2)(3)(4). The emitting distal part of a special light guide (applicator) is positioned within the central portion of a tumor, which is then irradiated with (infrared) laser light.…”

mentioning

confidence: 99%

Simulations of thermal tissue coagulation and their value for the planning and monitoring of laser‐induced interstitial thermotherapy (LITT)

Puccini

Bär

Bublat

et al. 2003

Magnetic Resonance in Med

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confidence: 99%

Simulations of thermal tissue coagulation and their value for the planning and monitoring of laser‐induced interstitial thermotherapy (LITT)

Puccini

Bär

Bublat

et al. 2003

Magnetic Resonance in Med

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“…As the laser-induced enhancing rim persists over a long period, difficulties may arise in differentiating the residual laser lesion from recurrent tumor. The sequential time course of the laser-induced enhancing rim with an ongoing reduction of size may exclude a recurrent tumor that appears as increasing volume and new onset of mass effect [8].…”

Section: Discussionmentioning

confidence: 99%

“…Although laser irradiation of brain tumors has been described early [8,16,17] most of the work refers to astrocytomas of WHO grade II-III and gliosarcomas [18]. In these studies, laser irradiation was performed with comparatively low irradiation doses [8,16,17] and less sophisticated application devices [8,16]. Nevertheless, it was demonstrated that energy amounts between 2400 and 9120 J were sufficient to induce coagulation necroses between 18 and 35 mm in diameter [19].…”

Section: Discussionmentioning

confidence: 99%

“…The primary lesion shows differences in lesion diameter corresponding to the irradiation time and thermal energy deposition to the tissue. The typical architecture of a laser lesion consists of a central coagulation necrosis which is not apparent immediately after irradiation but is demarcated by a surrounding rim of edema adjacent to undamaged tissue [7,8], visible in early MR controls and follow-ups. The necrosis becomes evident by a gradual loss of contrast medium enhancement (gadolinium, Gd) and early resorptive changes in the margins by day 3.…”

Section: Zones Of Lesionmentioning

confidence: 99%

“…Intravascular erythrolysis, a common phenomenon after laser irradiation, seems to be caused by a leakage of hemoglobin through defects in the cellular membranes of erythrocytes and may lead to vascular occlusion with secondary tissue damage. The interstitial appearance of serum proteins such as albumin which do not cross the blood-brain-barrier and typically are not detectable in the interstitium under normal conditions can be attributed to membranous defects of the capillary endothelium [8,11,13]. The underlying laser-tissue interaction and the resulting histological changes are well-defined and have been characterized as central coagulation necrosis and peripheral edema, subsequent resorptive changes and the formation of a rim of granulation tissue.…”

Section: Membrane Alterationsmentioning

confidence: 99%

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Interstitial laser irradiation of cerebral gliomas – neurobiological background, technique and typical results

Tempelhoff

Frank²,

Schwarzmaier³

2014

Photonics &Amp; Lasers in Medicine

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Background:The most common type of primary brain tumors are gliomas. For patients unsuitable for open microsurgery having been treated by radiochemotherapy, laser irradiation has proven to be an alternative palliative option. From summer 1997 until winter 2006 we performed about 60 laser-interstitial thermotherapy (LITT) treatments, starting with patients with large recurrent tumors who had no other therapeutic option. In the present article we report about the neurobiological background, the technique and our experience with LITT of cerebral gliomas.Materials and method:For laser irradiation we used a specially designed light guide (LITT standard applicator; Trumpf Medizintechnik, Umkirch, Germany). The tip of this light guide is a special optical diffuser which is characterized by a homogeneous spherical or ellipsoid emission profile. The light guide was introduced into an appropriate protective sheath (Somatex, Teltow, Germany). For the laser light source, we used a continuous wave 1064-nm Nd:YAG laser (mediLas fibertom 4060 N; Dornier MedTech, Weßling, Germany). Laser irradiation was performed under general anesthesia in a 0.5 T open configuration magnetic resonance (MR) system (Signa SP; General Electric, Milwaukee, WI, USA). Usually, the tip of the light guide was positioned in the center of the tumor using the built-in localization system (Flashpoint 3000; IGT, Boulder, CO, USA) in combination, where appropriate, with a specially designed navigation system (Localite™, Bonn, Germany). The position of the light guide was then controlled using multiplanar reconstructions of T1-weighted sequences. For near real-time control, temperature monitoring was performed using an experimental software package based on the temperature-dependent shift of the MR signal. Laser irradiation was ceased when the temperature monitoring revealed a steady state temperature profile within the heated tissue. Since 2008 we have used traditional stereotactic targeting and methionine positron emission tomography/computed tomography (MET-PET/CT) instead of the ‘open’ MR system for planning and follow-up in LITT of brain tumors.Results:We started the LITT treatment of gliomas in the early 1990s (benign gliomas in eloquent regions/not suitable for surgery). In 1997 we started to treat patients with recurrent gliobastomas/anaplastic gliomas. All of these patients had an increased survival in comparison to the natural course of recurrent glioblastomas. There were no procedure-related deaths or permanent neurological deficits. Two factors seem to be important for the overall success of the LITT procedure: 1) an early enrollment in the LITT therapy after diagnosis of a tumor recurrence, and 2) a corresponding smaller tumor mass at the beginning of the therapy.Conclusion:Cytoreduction by laser irradiation seems to be a promising option for patients suffering from gliomas.

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In Situ temperature measurements with thermocouple probes during laser interstitial thermotherapy (LITT): Quantification and correction of a measurement artifact

Manns¹,

Milne²,

González-Cirre³

et al. 1998

Lasers Surg. Med.

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MRI-Guided Laser-Induced Interstitial Thermotherapy of Cerebral Neoplasms

Cited by 256 publications

References 0 publications

Simulations of thermal tissue coagulation and their value for the planning and monitoring of laser‐induced interstitial thermotherapy (LITT)

Simulations of thermal tissue coagulation and their value for the planning and monitoring of laser‐induced interstitial thermotherapy (LITT)

Interstitial laser irradiation of cerebral gliomas – neurobiological background, technique and typical results

In Situ temperature measurements with thermocouple probes during laser interstitial thermotherapy (LITT): Quantification and correction of a measurement artifact

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