Intracerebral laser interstitial thermal therapy followed by tumor resection to minimize cerebral edema.
OBJECTIVE Laser interstitial thermal therapy (LITT) is used in numerous neurosurgical applications including lesions that are difficult to resect. Its rising popularity can be attributed to its minimally invasive approach, improved accuracy with real-time MRI guidance and thermography, and enhanced control of the laser. One of its drawbacks is the possible development of significant edema, which contributes to extended hospital stays and often necessitates hyperosmolar or steroid therapy. Here, the authors discuss the use of minimally invasive craniotomy to resect tissue ablated with LITT in attempt to minimize cerebral edema. METHODS Five patients with glioblastoma multiforme prospectively underwent LITT followed by resection. The LITT was performed with the aid of an MR-compatible skull-mounted frame in the MRI suite. Ablated tumor was then resected via small craniotomy by using the NICO Myriad system or cavitron ultrasonic surgical aspirator. Postoperative management involved dexamethasone administration slowly tapered over several weeks. RESULTS The use of resection following LITT, as compared with open resection or LITT alone, did not extend the hospital stay except in 1 patient who required 3-day inpatient management of edema with a trapped ventricle. No new neurological deficits were encountered, although 1 patient developed seizures postoperatively. No increase in infection rates was identified. CONCLUSIONS Resection of ablated tumor is a viable option to reduce the incidence of neurological deficits due to edema following LITT. This approach appears to mitigate cerebral edema by increasing available volume for mass effect and reducing the tissue burden that may promote an inflammatory response.
School of Medicine, University of Missouri at Kansas City; and.
Sindhura
S
Pisipati
Department of Neurosurgery, University of Kansas Medical Center, Kansas City, Kansas.
Kyle A
KA
Smith
Department of Neurosurgery, University of Kansas Medical Center, Kansas City, Kansas.
Kushal
K
Shah
Department of Neurosurgery, University of Kansas Medical Center, Kansas City, Kansas.
Koji
K
Ebersole
Department of Neurosurgery, University of Kansas Medical Center, Kansas City, Kansas.
Roukoz B
RB
Chamoun
Department of Neurosurgery, University of Kansas Medical Center, Kansas City, Kansas.
Paul J
PJ
Camarata
D001929:Brain Edema / Q000209:etiology / Q000601:surgery*; D001932:Brain Neoplasms / Q000601:surgery; D003399:Craniotomy / Q000009:adverse effects; D005260:Female; D005909:Glioblastoma / Q000601:surgery; D006801:Humans; D021621:Imaging, Three-Dimensional; D053685:Laser Therapy / Q000379:methods*; D008279:Magnetic Resonance Imaging; D008297:Male; D011446:Prospective Studies; D012189:Retrospective Studies; D016896:Treatment Outcome
CUSA = cavitron ultrasonic surgical aspirator; GBM = glioblastoma multiforme; LITT; LITT = laser interstitial thermal therapy; MRgLITT = MRI-guided LITT; TDT = thermal damage threshold; ablation; brain tumor; cerebral edema; laser therapy