Ahead of Print: Minimally-invasive Surgery for Subinsular Tumor
Background and Importance: To describe the novel use of AutoLITT(R) System (Monteris Medical, Winnipeg, MB) for focused laser interstitial thermal therapy (LITT) using intraoperative MRI and stereotactic image guidance for the treatment of metastatic adenocarcinoma to the left insula.
Clinical Presentation: The patient is a 61-year-old right-handed male with a history of metastatic adenocarcinoma of the colon. He has previously undergone resection of multiple lesions, Gamma Knife and whole brain radiation. Despite treatment to a left insular tumor, serial imaging revealed that the lesion continued to enlarge. Given the refractory nature of this tumor to radiation and the deep seated location, the patient elected to undergo LITT treatment. The center of the lesion and entry point on the scalp were identified using STEALTH (Medtronic, Memphis, TN) image-guided navigation. The AXiiiS(R) Stereotactic Miniframe (Monteris Medical, Winnipeg, MB) for the LITT system was secured onto the skull and a trajectory was defined to achieve access to the centroid of the tumor. After performing a burr hole, a gadolinium template probe was inserted into the AXiiiS base. The trajectory was confirmed via an intraoperative MRI and the LITT probe driver was attached to the base and CO2-cooled, side-firing laser LITT probe. The laser was activated and thermometry images were obtained. Two trajectories, posterior-medial and antero-lateral, produced satisfactory tumor ablation.
Conclusion: LITT using intraoperative MRI and stereotactic image guidance is a newly-available, minimally-invasive, and therapeutically viable technique for the treatment of deep seated brain tumors.
From: MRI-guided Focused Laser Interstitial Thermal Therapy for Subinsular Metastatic Adenocarcinoma: Technical Case Report by Hawasli et al.