Perioperative and Anesthetic Considerations for Neurosurgical Laser Interstitial Thermal Therapy Ablations

Jimenez-Ruiz, Federico; Arnold, Benjamin; Tatsui, Claúdio E.; Cata, Juan P.

doi:10.1097/ana.0000000000000376

Cited by 15 publications

(3 citation statements)

References 56 publications

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“…Although the majority of procedures are performed supine, LITT procedures may also require the lateral and prone positions increasing the inherent risk of losing the airway. 11 Although airway management with various other versions of the Leksell frame has been previously investigated using both an LMA or ETT, there has never been to our knowledge any investigations assessing airway management with G series frame where the straight front bar obscures oral access nor described this technique for rapidly removing the front bar on a Leksell headframe.…”

Section: Discussionmentioning

confidence: 99%

Airway Management with Leksell Frame in situ with or without Frontal Bar: A Mannequin Study

Dalby

Iorio-Morin

Kalia

et al. 2021

Can. J. Neurol. Sci.

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Background: The use of stereotactic headframes for neurosurgical procedures requiring targeted localization continues to grow with new advancements in technology and treatment modalities. A configuration of the Leksell stereotactic G frame with a straight front bar, useful in epilepsy and laser cases, almost completely obscures oral access and presents a significant airway challenge for the anesthetist. Although previous papers have suggested that the entire headframe should be removed during an airway emergency, we describe a novel method to remove only the front bar. Methods: We performed an observational mannequin study. Anesthesia personnel from a single center were asked to intubate a mannequin with the Leksell frame fully in situ and again with the front bar removed. In addition, the time to remove the entire frame versus only the front bar was investigated. Results: Eighteen anesthesia personnel participated in the study as well as four neurosurgeons. The average time to intubate the mannequin in the frame was 23.5 (11.4) seconds and with the front bar removed, 10.9 (2.5) seconds (p < 0.001). The average time taken to remove just the front bar by the neurosurgeons was 35.4 (7.3) seconds compared to an average of 83.3 (18.6) seconds to remove the headframe entirely (p < 0.001). Conclusion: Our study demonstrates that intubating with the Leksell front bar in situ is possible with videolaryngoscopy under an ideal situation. More importantly, the removal of just the front bar is a simpler more streamlined approach requiring statistically less time to secure an airway.

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Section: Discussionmentioning

confidence: 99%

Airway Management with Leksell Frame in situ with or without Frontal Bar: A Mannequin Study

Dalby

Iorio-Morin

Kalia

et al. 2021

Can. J. Neurol. Sci.

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“…12 Laser ablation is associated with shorter hospital stays, minimal pain, faster recovery, improved cosmetic outcomes, and delivery of a surgical cure while minimizing the disruption of family life. 24 Introduced by Achslogh in 1964, surgery has been described as an option for treatment of intractable epilepsyrelated with tuberous sclerosis. 22 Classic surgical options for these patients include resection of the epileptic focus, corpus callosotomy, and vagal nerve stimulation.…”

Section: Discussionmentioning

confidence: 99%

Single and staged laser interstitial thermal therapy ablation for cortical tubers causing refractory epilepsy in pediatric patients

Tovar-Spinoza¹,

Ziechmann²,

Zyck³

2018

Neurosurgical Focus

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OBJECTIVEMagnetic resonance–guided laser interstitial thermal therapy (MRgLITT) is a novel, minimally invasive treatment for the surgical treatment of epilepsy. In this paper, the authors report on clinical outcomes for a series of pediatric patients with tuberous sclerosis complex (TSC) and medication-refractory epileptogenic cortical tubers.METHODSA retrospective chart review was performed at SUNY Upstate Golisano Children’s Hospital in Syracuse, New York. The authors included all cases involving pediatric patients (< 18 years) who underwent MRgLITT for ablation of epileptogenic cortical tubers between February 2013 and November 2015.RESULTSSeven patients with cortical tubers were treated (4 female and 3 male). The patients’ average age was 6.6 years (range 2–17 years). Two patients had a single procedure, and 5 patients had staged procedures. The mean time between procedures in the staged cases was 6 months. All of the patients had a meaningful reduction in seizure frequency as reported by Engel and ILAE seizure outcome classifications, and most (71.4%) of the patients experienced a reduction in AED burden. Three of the 4 patients who presented with neuropsychiatric symptoms had some improvement in these domains after laser ablation. No perioperative complications were noted. The mean duration of follow-up was 19.3 months (range 4–49 months).CONCLUSIONSLaser ablation represents a minimally invasive alternative to resective epilepsy surgery and is an effective treatment for refractory epilepsy due to cortical tubers.

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“…16 Cordonnier et al have summarized the current management of acute ICH. 17 Finally, excellent discussions of the anesthetic care for patients undergoing novel functional and laser ablation neurosurgical procedures were provided by Dunn et al and Jimenez-Ruiz et al 18,19…”

Section: Narrative Reviews Of Interestmentioning

confidence: 99%

Year in Review: Synopsis of Selected Articles in Neuroanesthesia and Neurocritical Care from 2018

Rogan

Chowdhury

Venkatraghavan

2019

Journal of Neuroanaesthesiology and Critical Care

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Perioperative and Anesthetic Considerations for Neurosurgical Laser Interstitial Thermal Therapy Ablations

Cited by 15 publications

References 56 publications

Airway Management with Leksell Frame in situ with or without Frontal Bar: A Mannequin Study

Airway Management with Leksell Frame in situ with or without Frontal Bar: A Mannequin Study

Single and staged laser interstitial thermal therapy ablation for cortical tubers causing refractory epilepsy in pediatric patients

Year in Review: Synopsis of Selected Articles in Neuroanesthesia and Neurocritical Care from 2018

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