Stereotactic Cryodestruction of Gliomas

Abstract

Surgical resection of gliomas affecting functionally important brain structures is associated with high risk of permanent postoperative neurological deficit and deterioration of the patient's quality of life. The availability of modern neuroimaging and neuronavigation permits the application of minimally invasive stereotactic cryodestruction of the tumor in such cases. The authors used this treatment in 88 patients with supratentorial gliomas of various WHO histopathological grades not suitable for microsurgical resection. Postoperative mortality (1.1%) and rate of surgical complications (11.4%) were comparable to reported results of stereotactic brain tumor biopsy, whereas the rate of neurological morbidity (42%) was comparable to outcome after resection of gliomas within eloquent brain areas. The majority of complications were temporary, and permanent deterioration of neurological function was noted in 8% of cases only. The median survival after treatment in patients with glioblastoma and anaplastic astrocytoma was 12.4 and 46.9 months, respectively, and was not reached in cases of diffuse astrocytoma, which compared favorably both with historical controls and literature data. Therefore, it seems reasonable to consider stereotactic cryodestruction in multimodality management strategies of "unresectable" intracranial gliomas, and further studies directed at evaluation of its efficacy are definitely needed.

Does interventional MRI-guided brain cryotherapy cause a blood–brain barrier disruption? Radiological analysis and perspectives

“…After the procedure, each patient was admitted to our neurosurgical high dependency unit where a rigorous neurological monitoring was carried out for a mean of 6 days (5)(6)(7)(8). Afterwards, the patient was transferred to the standard ward with a mean in-hospital stay of 13.6 days (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21). Upon discharge, the patient underwent clinical and radiological follow-up at 6 weeks and thereafter every 3 months for the first 2 years (Table 1).…”

“…Pertinent literature has already reported the role of the IMRgC [19] in managing brain metastases; the latter could likely represent an alternative treatment for gliomas [16]. MR guidance enables precise lesion targeting, facilitating optimal treatment margins while avoiding inadvertent parenchymal damage [17].…”

“…In this context of therapeutic challenge, brain cryotherapy appears to be a new treatment option. Cryoablation represented an established treatment for extracranial tumors such as kidney, lung, breast, and bone [15] but not yet for brain glioblastoma [16].…”

Preclinical cerebral cryoablation in non-tumor bearing pigs

“…Cryoablation is a procedure in which a cryoprobe is used to freeze and destroy abnormal tissue; this approach has been successfully applied in a variety of malignancies including renal cancer and primary and secondary hepatic cancers 2 , 3 , but not yet for the treatment of secondary cerebral malignancies. Although cryoablation is a minimal invasive procedure, complications such as edema and hemorrhages are seen; in the brain, these could lead to neurological deficits 4 , 5 .…”

In situ terahertz monitoring of an ice ball formation during tissue cryosurgery: a feasibility test

“…28 In particular, the use of cryosurgery for the treatment of brain tumors and epilepsy is currently limited by the possible risks for the patient. [32][33][34] Such guiding techniques as ultrasonography, 35,36 magnetic resonance, and computer imaging [37][38][39][40][41][42] do not enable the monitoring of the tissue freezing in situ with high spatial resolution near the cryoprobe. Alternative approach is based on measuring of tissue temperature using thermocouples (TCs) combined with cryoprobe.…”