title: Intraoperative real-time MRI-guided stereotactic biopsy followed by laser thermal ablation for progressive brain metastases after radiosurgery.
abstract: Stereotactic radiosurgery is one of the treatment options for brain metastases. However, there are patients who will progress after radiosurgery. One of the potential treatments for this subset of patients is laser ablation. Image-guided stereotactic biopsy is important to determine the histopathological nature of the lesion. However, this is usually based on preoperative, static images, which may affect the target accuracy during the actual procedure as a result of brain shift. We therefore performed real-time intraoperative MRI-guided stereotactic aspiration and biopsies on two patients with symptomatic, progressive lesions after radiosurgery followed immediately by laser ablation. The patients tolerated the procedure well with no new neurologic deficits. Intraoperative MRI-guided stereotactic biopsy followed by laser ablation is safe and accurate, providing real-time updates and feedback during the procedure.
authors.affiliation: Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
authors.forename: Roy G
authors.initials: RG
authors.lastname: Torcuator
authors.affiliation: Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA. Electronic address: awael58@gmail.com.
authors.forename: M Maher
authors.initials: MM
authors.lastname: Hulou
authors.affiliation: Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
authors.forename: Vamsidhar
authors.initials: V
authors.lastname: Chavakula
authors.affiliation: Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
authors.forename: Ferenc A
authors.initials: FA
authors.lastname: Jolesz
authors.affiliation: Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
authors.forename: Alexandra J
authors.initials: AJ
authors.lastname: Golby
mesh_terms: D001932:Brain Neoplasms / Q000556:secondary / Q000601:surgery*; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods*; D021621:Imaging, Three-Dimensional / Q000379:methods; D053685:Laser Therapy / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D059906:Neuroimaging / Q000379:methods*; D016634:Radiosurgery / Q000379:methods*
keywords: Laser ablation; Metastasis; Radiation necrosis; Radiosurgery; Real time iMRI biopsy