Utilizing personalized stereotactic frames for laser interstitial thermal ablation of posterior fossa and mesiotemporal brain lesions: a single-institution series.
OBJECTIVE The precision of laser probe insertion for interstitial thermal therapy of deep-seated lesions is limited by the method of stereotactic guidance. The objective of this study was to evaluate the feasibility of customized STarFix 3D-printed stereotactic platforms to guide laser probe insertion into mesiotemporal and posterior fossa targets. METHODS The authors conducted a retrospective review of 5 patients (12-55 years of age) treated with laser interstitial thermal therapy (LITT) in which STarFix platforms were used for probe insertion. Bone fiducials were implanted in each patient's skull, and subsequent CT scans were used to guide the design of each platform and incorporate desired treatment trajectories. Once generated, the platforms were mounted on the patients' craniums and used to position the laser probe during surgery. Placement of the laser probe and the LITT procedure were monitored with intraoperative MRI. Perioperative and follow-up MRI were performed to identify and monitor changes in target lesions. RESULTS Accurate placement of the laser probe was observed in all cases. For all patients, thermal ablation was accomplished without intraoperative complications. Of the 4 patients with symptomatic lesions, 2 experienced complete resolution of symptoms, and 1 reported improved symptoms compared with baseline. CONCLUSIONS Customized stereotactic platforms were seamlessly incorporated into the authors' previously established LITT workflow and allowed for accurate treatment delivery.
Department of Neurological Surgery, and.|Medical Scientist Training Program, Washington University School of Medicine, St. Louis, Missouri.
David Y A
DY
Dadey
Department of Neurological Surgery, and.
Ashwin A
AA
Kamath
Department of Neurological Surgery, and.
Matthew D
MD
Smyth
Department of Neurological Surgery, and.
Michael R
MR
Chicoine
Department of Neurological Surgery, and.
Eric C
EC
Leuthardt
Department of Neurological Surgery, and.
Albert H
AH
Kim
D000293:Adolescent; D000328:Adult; D001932:Brain Neoplasms / Q000601:surgery*; D002648:Child; D003388:Cranial Fossa, Posterior / Q000601:surgery*; D004569:Electroencephalography; D004827:Epilepsy / Q000601:surgery*; D005260:Female; D006801:Humans; D053685:Laser Therapy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography; D012189:Retrospective Studies; D013702:Temporal Lobe / Q000601:surgery*; D015899:Tomography, Emission-Computed, Single-Photon; D055815:Young Adult
3D-printed frame; DBS = deep brain stimulation; EEG = electroencephalography; ICU = intensive care unit; LITT; LITT = laser interstitial thermal therapy; STarFix; TDT = thermal damage threshold; brain tumor; laser interstitial thermal therapy; mT = microTargeting; stereotactic guidance