Tag: Laser

Posted on

Laser interstitial thermal therapy for cavernous malformations: a meta-analysis of individual patient-level data

J Neurosurg 142:1014–1024, 2025

Laser interstitial thermal therapy (LITT) shows promise for treating cavernous malformations, offering high seizure freedom rates and significant CM volume reduction. Immediate neurological deficits are a risk but often transient. Further research is needed for long-term outcomes and safety validation.

• Study Objective: Evaluate laser interstitial thermal therapy (LITT) for cavernous malformations (CMs).

• Methodology: PRISMA-compliant systematic review and patient-level data meta-analysis.

• Patient Demographics: 39 patients, 28 with epilepsy, treated at six centers.

• Seizure Freedom Rate: 88% at last follow-up for epilepsy patients.

• Immediate Postoperative Deficits: 15.4% experienced transient neurological deficits.

• CM Volume Reduction: 73.7% for epileptogenic, 53.8% for nonepileptogenic CMs.

• No Perioperative Hemorrhage: No reported hemorrhages during or after procedures.

• Study Limitations: Small patient cohort, limited follow-up time.

• Predictors of Seizure Freedom: No significant predictors identified.

• Adverse Events Analysis: No significant predictors for adverse events post-LITT.

• Radiographic Outcomes: No significant differences based on CM location.

• Pooled Effect Size Analysis: Frequentist and Bayesian models used for volume reduction estimates.

• Future Research Needs: Larger cohorts and longer follow-up required for validation.

Posted on

A stereotactic frame‐based drill guide‐aided setting for laser interstitial thermal therapy

Acta Neurochirurgica (2021) 163:3447–3453

Magnetic resonance imaging (MRI)-guided laser interstitial thermal therapy (MRIgLITT) was demonstrated to be a viable neurosurgical tool. Apart from its variety of indications, different operative and technical nuances exist. In the present report, for the first time, the use and ability of a traditional Riechert-Mundinger (RM) stereotactic system combined with a novel drill guide kit for MRIgLITT are described.

Methods A stereotactic frame-based setting was developed by combining an RM system with a drill guide kit and centering bone anchor screwing aid for application together with an MRIgLITT neuro-accessory kit and cooled laser applicator system. The apparatus was used for stereotactic biopsy and consecutive MRIgLITT with an intraoperative high-field MRI scanner in a brain tumor case.

Results The feasibility of an RM stereotactic apparatus and a drill guide kit for MRIgLITT was successfully assessed. Both stereotactic biopsy and subsequent MRIgLITT in a neurooncological patient could easily and safely be performed. No technical problems or complications were observed.

Conclusion The combination of a traditional RM stereotactic system, a new drill guide tool, and intraoperative high-field MRI provides neurosurgeons with the opportunity to reliably confirm the diagnosis by frame-based biopsy and allows for stable and accurate real-time MRIgLITT.

Posted on

Staged Laser Interstitial Thermal Therapy (LITT) Treatments to Left Insular Low-Grade Glioma

Neurosurgery 2019 DOI:10.1093/neuros/nyz120

Low-grade insular gliomas remain challenging tumors for aggressive resection because of the numerous functional and vascular structures surrounding them. Because of the potential morbidities associated with open surgical resection, less invasive techniques may confer a more optimal balance between cytoreduction and surgical complications. For this reason, we evaluated the use of laser interstitial thermal therapy (LITT) for resection of a dominant hemisphere oligodendroglioma World Health Organization (WHO) grade II in a 68-yr-old patient by use of multiple staged surgeries for its resection.

CLINICAL PRESENTATION: Patient KK was a 68-yr-old female who was found to have a large, left-sided insular mass that was shown to be an oligodendroglioma WHO grade II, positive for codeletion 1p/19q and IDH1 mutant on biopsy. Over the course of 3 mo, KK underwent 2 stages of LITT, targeting different areas of the 5-cmtumor. The 60-d magnetic resonance imaging (MRI) demonstrated a reduction in size of the tumor from5.2×3.3×2.4 cm to 3.6 × 1.9 × 1.4 cm. She returned for a second stage targeting the anterior portion of the tumor. KK did well postoperatively and went on to postsurgical chemoradiation. At the
2-yr follow-up, the lesion showed near resolution on MRI.

CONCLUSION: This case report demonstrates successful use of LITT for staged surgeries to treat a left hemisphere-dominant insular lesion. This establishes the use of LITT as a viable, minimally invasive option to treat tumors that are difficult to access or pose concerns for increased morbidity through an open surgery.

Posted on

Laser Interstitial Thermal Therapy for Mesial Temporal Lobe Epilepsy

Neurosurgery 79:S83–S91, 2016

Approximately one-third of patients with epilepsy do not achieve adequate seizure control through medical management alone. Mesial temporal lobe epilepsy (MTLE) is one of the most common forms of medically refractory epilepsy referred for surgical management. Stereotactic laser amygdalohippocampotomy using magnetic resonance–guided laser interstitial thermal therapy (MRg-LITT) is an important emerging therapy for MTLE.

Initial published reports support MRg-LITT as a less invasive surgical option with a shorter hospital stay and fewer neurocognitive side effects compared with craniotomy for anterior temporal lobectomy with amygdalohippocampectomy and selective amygdalohippocampectomy.

We provide a historical overview of laser interstitial thermal therapy development and the technological advancements that led to the currently available commercial systems. Current applications of MRg-LITT for MTLE, reported outcomes, and technical issues of the surgical procedure are reviewed. Although initial reports indicate that stereotactic laser amygdalohippocampotomy may be a safe and effective therapy for medically refractory MTLE, further research is required to establish its long-term effectiveness and its cost/benefit profile.

Proudly powered by WordPress