Safety of stereotactic laser ablations performed as treatment for glioblastomas in a conventional magnetic resonance imaging suite.
OBJECTIVE Stereotactic laser ablation (SLA) is typically performed in the setting of intraoperative MRI or in a staged manner in which probe insertion is performed in the operating room and thermal ablation takes place in an MRI suite. METHODS The authors describe their experience, in which SLA for glioblastoma (GBM) treatment was performed entirely within a conventional MRI suite using the SmartFrame stereotactic device. RESULTS All 10 patients with GBM (2 with isocitrate dehydrogenase 1 mutation [mIDH1] and 8 with wild-type IDH1 [wtIDH1]) were followed for > 6 months. One of these patients underwent 2 independent SLAs approximately 12 months apart. Biopsies were performed prior to SLA for all patients. There were no perioperative morbidities, wound infections, or unplanned 30-day readmissions. The average time for a 3-trajectory SLA (n = 3) was 436 ± 102 minutes; for a 2-trajectory SLA (n = 4) was 321 ± 85 minutes; and for a single-trajectory SLA (n = 4) was 254 ± 28 minutes. No tumor recurrence occurred within the blue isotherm line ablation zone, although 2 patients experienced recurrence immediately adjacent to the blue isotherm ablation line. Overall survival for the patient cohort averaged 356 days, with the 2 patients who had mIDH1 GBMs exhibiting the longest survival (811 and 654 days). CONCLUSIONS Multitrajectory SLA for treatment of GBM can be safely performed using the SmartFrame stereotactic device in a conventional MRI suite.
Departments of 1 Neurosurgery.
Robert C
RC
Rennert
Departments of 1 Neurosurgery.
Kate T
KT
Carroll
Departments of 1 Neurosurgery.
Mir Amaan
MA
Ali
Radiology, and.
Thomas
T
Hamelin
Anesthesia, University of California, San Diego, California.
Leon
L
Chang
Departments of 1 Neurosurgery.
Brian P
BP
Lemkuil
Departments of 1 Neurosurgery.
Clark C
CC
Chen
D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D005909:Glioblastoma / Q000000981:diagnostic imaging* / Q000235:genetics / Q000601:surgery*; D006801:Humans; D021621:Imaging, Three-Dimensional; D007521:Isocitrate Dehydrogenase / Q000235:genetics; D053685:Laser Therapy / Q000379:methods*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009154:Mutation / Q000235:genetics; D013238:Stereotaxic Techniques; D016896:Treatment Outcome
D007521:Isocitrate Dehydrogenase; C543588:IDH1 protein, human
GBM = glioblastoma; MR thermography; RT = radiation therapy; SLA = stereotactic laser ablation; TMZ = temozolomide; intraoperative MRI; neurooncology; stereotactic laser ablation