Stereotactic laser ablation for hypothalamic and deep intraventricular lesions

Abstract

<jats:sec> <jats:title>OBJECTIVE</jats:title> <jats:p>Laser ablation is a novel, minimally invasive procedure that utilizes MRI-guided thermal energy to treat epileptogenic and other brain lesions. In addition to treatment of mesial temporal lobe epilepsy, laser ablation is increasingly being used to target deep or inoperable lesions, including hypothalamic hamartoma (HH), subependymal giant cell astrocytoma (SEGA), and exophytic intrinsic hypothalamic/third ventricular tumors. The authors reviewed their early institutional experience with these patients to characterize clinical outcomes in patients undergoing this procedure.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>A retrospective cohort (n = 12) of patients undergoing laser ablation at a single institution was identified, and clinical and radiographic records were reviewed.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>Laser ablation was successfully performed in all patients. No permanent neurological or endocrine complications occurred; 2 (17%) patients developed acute obstructive hydrocephalus or shunt malfunction following treatment. Laser ablation of HH resulted in seizure freedom (Engel Class I) in 67%, with the remaining patients having a clinically significant reduction in seizure frequency of greater than 90% compared with preoperative baseline (Engel Class IIB). Treatment of SEGAs resulted in durable clinical and radiographic tumor control in 2 of 3 cases, with one patient receiving adjuvant everolimus and the other receiving no additional therapy. Palliative ablation of hypothalamic/third ventricular tumors resulted in partial tumor control in 1 of 3 patients.</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>Early experience suggests that laser ablation is a generally safe, durable, and effective treatment for patients harboring HHs. It also appears effective for local control of SEGAs, especially in combination therapy with everolimus. Its use as a palliative treatment for intrinsic hypothalamic/deep intraventricular tumors was less successful and associated with a higher risk of serious complications. Additional experience and long-term follow-up will be beneficial in further characterizing the effectiveness and risk profile of laser ablation in treating these lesions in comparison with conventional resective surgery or stereotactic radiosurgery.</jats:p></jats:sec>

Laser interstitial thermal therapy for pediatric atypical teratoid/rhabdoid tumor: case report

“…In the adult population, LITT has been used to treat gliomas, 22 recurrent metastases, 17 radiation necrosis, 20 mesial temporal sclerosis, 16,26 epidural spinal metastasis with cord compression, 21 and other pathologies. Its advantages have also been translated to the management of pediatric pathologies, such as in the successful reduction of seizure burden in the treatment of pediatric epilepsy for etiologies including focal cortical dysplasia, 3 mesial temporal lobe sclerosis, 14 and hypothalamic hamartoma, 27 among others (Table 1). 12,13 Kuo et al demonstrated successful reduction in tumor volume and associated symptoms in patients with gangliogliomas, radiation necrosis, focal cortical dysplasia, and gliosis.…”

Hyperthermia treatment advances for brain tumors

“…LITT has also been advocated for newly diagnosed and recurrent pediatric brain tumors [136]. LITT-treated pathologies include: pilocytic astrocytomas [136][137][138], ependymomas [77,103,139], medulloblastomas [136,138], choroid plexus xanthogranulomas [136,138], subependymal giant cell astrocytomas [136,138,[140][141][142], gangliogliomas [136,138,143], neuroectodermal tumors [77,103,144], gliosis [143], RN [143] and hypothalamic hamartomas [140]. Reported indications include deep-seated and recurrent, tumors [136,145].…”

Emerging indications for stereotactic laser interstitial thermal therapy in pediatric neurosurgery

“…Other complications include hyponatremia, weight gain, procedural related hemorrhage, transient seizure worsening, and hormonal dysfunction [5]. While laser ablation for palliative treatment of intrinsic hypothalamic tumors has been shown to be associated with a higher risk of serious adverse events, LITT is increasingly being utilized as a safe and effective treatment intervention for patients with deep or previously inoperable HH [37]. In a series of 71 adult HH patients who underwent laser ablation by Curry et al, over 90% achieved gelastic seizure freedom at 1-year follow-up with less than 25% of patients requiring a subsequent additional ablation [3].…”