Laser interstitial thermal therapy as a novel treatment modality for brain tumors in the thalamus and basal ganglia
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Jason L. Schroeder
Abstract
Introduction:
Deep-seated hemispheric brain tumors pose unique challenges for surgical treatment. These tumors are often considered inoperable and when surgery is undertaken significant, serious, morbidity and even mortality may complicate the outcome. Laser interstitial thermal therapy (LITT) is a minimally invasive alternative to traditional open surgery that affects tumor cell death by producing a zone of thermal tissue damage that can be monitored and controlled with the aid of real-time magnetic resonance thermography.
Subjects and methods:
A retrospective review of six patients treated with LITT at the Cleveland Clinic between 5/2011 and 8/2013 was performed. We evaluated clinical patient data and pre-, intra-, and post-operative magnetic resonance imaging (MRI) data for correlation.
Results:
Six patients were treated with a total of eight separate LITT procedures for their thalamic (n=5) or basal ganglia (n=1) tumors. All tumors were histologically malignant and five were primary tumors. Pre- and post-operative neurological deficits were recorded. The two patients that underwent multiple procedures were retreated for different reasons – one due to insufficient coverage and the other due to tumor recurrence. Sustained post-operative neurological deficits were observed after three procedures and one patient died within 2 days of surgery from a thalamic hemorrhage.
Conclusions:
LITT is a minimally invasive surgical treatment that can lead to successful ablation of tumors of the thalamus or basal ganglia. However, this treatment has the potential for neurological morbidity or even mortality and as such further studies are needed to evaluate the true risk vs. reward potential for LITT with regard to treating deep-seated tumors.
Zusammenfassung
Einleitung:
Tiefsitzende hemisphärische Gehirntumoren stellen eine besondere Herausforderung für die chirurgische Behandlung dar. Diese Tumoren werden häufig als inoperabel eingestuft. Wird eine Operation durchgeführt, so ist diese häufig mit einem schlechten Outcome durch die einhergehende hohe Morbidität und Mortalität verbunden. Die interstitielle Laser-Thermotherapie (LITT) stellt eine minimal-invasive Alternative zur traditionellen offenen Chirurgie dar. Bei diesem Verfahren werden die Tumorzellen mittels Wärme zerstört, wobei die Ausdehnung der thermischen Gewebeschädigungszone mit Hilfe der Echtzeit-Magnetresonanz-Thermographie überwacht und gesteuert werden kann.
Patienten und Methoden:
Die vorliegende Arbeit ist eine retrospektive Studie von 6 Patienten, die im Zeitraum 5/2011 bis 8/2013 an der Cleveland-Klinik mittels LITT behandelt wurden. Untersucht wurden die klinischen Patientendaten sowie prä-, intra- und post-operative MRT-Daten für die Korrelation.
Ergebnisse:
Sechs Patienten mit Tumoren des Thalamus (n=5) oder der Basalganglien (n=1) wurden in insgesamt 8 LITT-Sessions behandelt. Alle Tumoren waren histologisch maligne, fünf waren Primärtumoren. Es wurden pre- und post-operative neurologische Defizite festgestellt. Zwei Patienten unterzogen sich einer mehrfachen Behandlung: ein Patient aufgrund unzureichender Abdeckung und der andere wegen eines Rezidivs. Nach drei Behandlungsprozeduren wurden anhaltende post-operative neurologische Defizite beobachtet. Ein Patient verstarb innerhalb von zwei Tagen nach der Operation durch eine Blutung im Thalamus.
Schlussfolgerungen:
Die LITT ist eine minimal-invasive chirurgische Behandlung, die zu einer erfolgreichen Ablation von Tumoren des Thalamus oder der Basalganglien führen kann. Allerdings birgt diese Behandlung das Risiko für neurologische Morbidität bis hin zur Mortalität. Daher sind weitere Studien erforderlich, um das tatsächliche Risiko-Nutzen-Verhältnis der LITT in Bezug auf die Behandlung von tief liegenden Tumoren evaluieren zu können.
Acknowledgments
Authors would like to thank Andrew O’Conner for his help in volumetric evaluation of tumors.
Conflict of interest statement
Dr. Gene Barnett is consultant medical director of Monteris Medical Corporation.
References
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©2014 by Walter de Gruyter Berlin/Boston
Articles in the same Issue
- Frontmatter
- Editorial
- Laser interstitial thermal therapy (LITT) of the brain – Experiences and new indications
- Magazine section
- Snapshots
- Reviews
- Laser interstitial thermal therapy with and without MRI guidance for treatment of brain neoplasms – A systematic review of the literature
- Laser interstitial thermal therapy for treatment of post-radiosurgery tumor recurrence and radiation necrosis
- MRI-guided laser interstitial thermal therapy of intracranial tumors and epilepsy: State-of-the-art review and a case study from pediatrics
- Original contributions
- Percutaneous selective laser amygdalo-hippocampectomy (SLAH) for treatment of mesial temporal lobe epilepsy within an interventional MRI suite
- Interstitial laser irradiation of cerebral gliomas – neurobiological background, technique and typical results
- Prognostic factors of overall survival after laser interstitial thermal therapy in patients with glioblastoma
- Laser interstitial thermal therapy as a novel treatment modality for brain tumors in the thalamus and basal ganglia
- Preliminary research report
- Endoscopic fluorescence visualization of 5-ALA photosensitized central nervous system tumors in the neural tissue transparency spectral range
- Congress announcements
- 21st Annual Meeting of the Deutsche Gesellschaft für Lasermedizin (DGLM) e.V.
- Congresses 2014/2015
Articles in the same Issue
- Frontmatter
- Editorial
- Laser interstitial thermal therapy (LITT) of the brain – Experiences and new indications
- Magazine section
- Snapshots
- Reviews
- Laser interstitial thermal therapy with and without MRI guidance for treatment of brain neoplasms – A systematic review of the literature
- Laser interstitial thermal therapy for treatment of post-radiosurgery tumor recurrence and radiation necrosis
- MRI-guided laser interstitial thermal therapy of intracranial tumors and epilepsy: State-of-the-art review and a case study from pediatrics
- Original contributions
- Percutaneous selective laser amygdalo-hippocampectomy (SLAH) for treatment of mesial temporal lobe epilepsy within an interventional MRI suite
- Interstitial laser irradiation of cerebral gliomas – neurobiological background, technique and typical results
- Prognostic factors of overall survival after laser interstitial thermal therapy in patients with glioblastoma
- Laser interstitial thermal therapy as a novel treatment modality for brain tumors in the thalamus and basal ganglia
- Preliminary research report
- Endoscopic fluorescence visualization of 5-ALA photosensitized central nervous system tumors in the neural tissue transparency spectral range
- Congress announcements
- 21st Annual Meeting of the Deutsche Gesellschaft für Lasermedizin (DGLM) e.V.
- Congresses 2014/2015
