Ahead of Print: Laser Interstitial Thermal Therapy

Screen Shot 2013-11-04 at 12.11.45 PMBackground: Surgical treatments for deep-seated intracranial lesions have been limited by morbidities associated with resection. Real-time magnetic resonance imaging-guided focused laser interstitial thermal therapy (LITT) offers a minimally-invasive surgical treatment option for such lesions.

Objective: To review treatments and results of patients treated with LITT for intracranial lesions at Washington University School of Medicine.

Methods: In a review of 17 prospectively-recruited LITT cases (ages 34-78, mean 59 years), we report demographics, treatment details, post-operative imaging characteristics, and peri- and post-operative clinical courses.

Results: Targets included 11 gliomas, 5 brain metastases and 1 epilepsy focus. Lesions were lobar (8), thalamic/basal ganglia (5), insular (3), or corpus callosum (1). Mean target volume was 11.6 cm3 and LITT produced 93% target ablation. Patients with superficial lesions had shorter ICU stays. Ten patients experienced no perioperative morbidities. Morbidities included transient aphasia, hemiparesis, hyponatremia, deep vein thrombosis, and a fatal meningitis. Postoperative MRI showed blood products within the lesion surrounded by new thin uniform rim of contrast enhancement and diffusion restriction. In conjunction with other therapies, LITT targets often showed stable or reduced local disease. Epilepsy focus LITT produced seizure-freedom at 8 months. Preliminary overall median progression-free survival and survival from LITT in tumor patients was 7.6 and 10.9 months, respectively. However, this small cohort has not been followed for a sufficient length of time, necessitating future outcomes studies.

Conclusion: Early peri- and post-operative clinical data demonstrate that LITT is a safe and viable ablative treatment option for intracranial lesions, and may be considered for select patients.

From: Magnetic Resonance Imaging-Guided Focused Laser Interstitial Thermal Therapy for Intracranial Lesions: Single-Institution Series by Hawasli et al.

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