Magnetic resonance imaging-guided focused laser interstitial thermal therapy for intracranial lesions: single-institution series.
BACKGROUND
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 patients (34-78 years of age; mean, 59 years), we report demographics, treatment details, postoperative imaging characteristics, and peri- and postoperative clinical courses.


RESULTS
Targets included 11 gliomas, 5 brain metastases, and 1 epilepsy focus. Lesions were lobar (n = 8), thalamic/basal ganglia (n = 5), insular (n = 3), and corpus callosum (n = 1). Mean target volume was 11.6 cm, and LITT produced 93% target ablation. Patients with superficial lesions had shorter intensive care unit stays. Ten patients experienced no perioperative morbidities. Morbidities included transient aphasia, hemiparesis, hyponatremia, deep venous thrombosis, and fatal meningitis. Postoperative magnetic resonance imaging 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 were 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.


CONCLUSIONS
Early peri- and postoperative clinical data demonstrate that LITT is a safe and viable ablative treatment option for intracranial lesions, and may be considered for select patients.
Departments of Neurosurgery and Mallinckrodt Institute of Radiology, Washington University School of Medicine, Washington University in St. Louis, St. Louis, Missouri.
Ammar H
AH
Hawasli
Swapnil
S
Bagade
Joshua S
JS
Shimony
Michelle
M
Miller-Thomas
Eric C
EC
Leuthardt
D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000401:mortality / Q000601:surgery*; D018572:Disease-Free Survival; D004827:Epilepsy / Q000401:mortality / Q000601:surgery*; D005260:Female; D006358:Hot Temperature; D006801:Humans; D053208:Kaplan-Meier Estimate; D053685:Laser Therapy / Q000009:adverse effects* / Q000379:methods*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000401:mortality; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted