A Systematic Review and Meta-Analysis of Studies Examining the Use of Brain Laser Interstitial Thermal Therapy versus Craniotomy for the Treatment of High-Grade Tumors in or near Areas of Eloquence: An Examination of the Extent of Resection and Major Complication Rates Associated with Each Type of Surgery.
The extent of resection (EOR) of high-grade gliomas (WHO grade III or IV) in or near areas of eloquence is associated with overall patient survival, but with higher major neurocognitive complications.



A systematic review and meta-analysis was undertaken of the peer-reviewed literature in order to identify studies which examined EOR or extent of ablation (EOA) and major complications (defined as neurocognitive or functional complications which last >3 months duration after surgery) associated with either brain laser interstitial thermal therapy (LITT) or open craniotomy in high-grade tumors in or near areas of eloquence.



Eight studies on brain LITT (n = 79 patients) and 12 craniotomy studies (n = 1,036 patients) were identified which examined either/both EOR/EOA and complications. Meta-analysis demonstrated an EOA/EOR of 85.4 ± 10.6% with brain LITT versus 77.0 ± 40% with craniotomy (mean difference: 8%; 95% CI: 2-15; p = 0.01; inverse variance, random effects model). Meta-analysis of proportions of major complications for each individual therapy demonstrated major complications of 5.7% (95% CI: 1.8-11.6) and 13.8% (95% CI: 10.3-17.9) for LITT and craniotomy, respectively.



In patients presenting with high-grade gliomas in or near areas of eloquence, early results demonstrate that brain LITT may be a viable surgical alternative.
Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Ridgewood, N.J., USA.
Gene H
GH
Barnett
Jeffrey D
JD
Voigt
Manmeet S
MS
Alhuwalia
D001921:Brain / Q000473:pathology / Q000601:surgery; D001932:Brain Neoplasms / Q000601:surgery*; D065711:Broca Area / Q000473:pathology / Q000601:surgery*; D003399:Craniotomy / Q000009:adverse effects*; D005910:Glioma / Q000601:surgery*; D006801:Humans; D053685:Laser Therapy / Q000009:adverse effects*; D019965:Neurocognitive Disorders / Q000209:etiology*