Magnetic resonance image-guided laser interstitial thermal therapy [Neurosurgery Wiki]

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====== Magnetic resonance image-guided laser interstitial thermal therapy ======

{{rss>https://pubmed.ncbi.nlm.nih.gov/rss/search/1VkhPsjWfHFYNYpcARD039JNnDlgNEJZJjEbJb3WPyjtwOXEm4/?limit=15&utm_campaign=pubmed-2&fc=20250210033854}}
 
[[Stereotactic robot-assisted MRI-guided laser interstitial thermal therapy thalamotomy]]
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[[Magnetic resonance image-guided laser interstitial thermal therapy]] uses thermal energy to induce cell death by damaging DNA and causing protein denaturation. The current therapy is performed with simultaneous MRI stereotactic guidance and real-time feedback from the ablated lesion.
((Willie JT, Laxpati NG, Drane DL, et al. Real-time magnetic resonance-guided stereotactic laser amygdalohippocampotomy for mesial temporal lobe epilepsy. Neurosurgery. 2014; 74:569–84; discussion 584-5))
((Curry DJ, Gowda A, McNichols RJ, et al. MR-guided stereotactic laser ablation of epileptogenic foci in children. Epilepsy Behav. 2012; 24:408–414)).

It is considered less invasive than microsurgery. Main advantage is a shorter postoperative recovery period. The technique has been used for lesional and nonlesional epilepsy. Preliminary seizure control ≈ 60–70%. No long-term data is yet available.
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Magnetic resonance-guided, [[Laser interstitial thermotherapy]] (LITT) is a real-time [[magnetic resonance thermometry]] - guided, minimally invasive [[procedure]] that uses a [[laser]] to produce a precise and minimally invasive heat injury to target tissue. 

To deliver this energy in a minimally invasive fashion, a small diameter fiber optic applicator is inserted into the lesion through a keyhole stereotactic procedure. The thermal energy induces damage to intracellular DNA and DNA-binding structures, ultimately leading to cell death. The ablation procedure is supervised by real-time MRI thermal mapping and confirmed by immediate post-ablation T1 or [[FLAIR]] MRI images.
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Magnetic resonance (MR)-guided stereotactic laser ablation is a minimally invasive alternative that uses small applicators amenable to stereotactic delivery. Heating is dependent on source wavelength such that a source laser can be chosen to produce rapid and localized heating of tissue with sharp boundaries at relatively low powers
((McNichols RJ, Gowda A, Kangasniemi M, et al.. MR thermometry-based feedback control of laser interstitial thermal therapy at 980 nm. Lasers Surg Med. 2004;34(1):48–55.)).

Because optical fibers and laser energy are MR imaging (MRI) compatible, simultaneous MR thermal imaging (MRTI), with accuracy on the order of ±0.2°C in a number of tissue types enables real-time feedback control of laser output and tissue ablation. MR-guided stereotactic laser ablation has been safely used for ablation of intracranial lesions including tumors and certain epileptogenic foci in children
((Carpentier A, McNichols RJ, Stafford RJ, et al.. Real-time magnetic resonance-guided laser thermal therapy for focal metastatic brain tumors. Neurosurgery. 2008;63(1 suppl 1):ONS21–ONS28; discussion ONS28-ONS29.))
((Carpentier A, McNichols RJ, Stafford RJ, et al.. Laser thermal therapy: real-time MRI-guided and computer-controlled procedures for metastatic brain tumors. Lasers Surg Med. 2011;43(10):943–950.))
((Carpentier A, Chauvet D, Reina V, et al.. MR-guided laser-induced thermal therapy (LITT) for Glioblastoma recurrences. Lasers Surg Med. 2012;44(5):361–368.))
((Jethwa PR, Lee JH, Assina R, Keller IA, Danish SF. Treatment of a supratentorial primitive neuroectodermal tumor using magnetic resonance-guided laser-induced thermal therapy. J Neurosurg Pediatr. 2011;8:468–475.))
((Jethwa PR, Barrese JC, Gowda A, Shetty A, Danish SF. Magnetic resonance thermometry-guided laser-induced thermal therapy for intracranial neoplasms: initial experience. Neurosurgery. 2012;71:ons133–ons145.))
((Curry DJ, Gowda A, McNichols RJ, Wilfong AA. MR-guided stereotactic laser ablation of epileptogenic foci in children. Epilepsy Behav. 2012;24(4):408–414.))
((Torres-Reveron J, Tomasiewicz HC, Shetty A, Amankulor NM, Chiang VL. Stereotactic laser induced thermotherapy (LITT): a novel treatment for brain lesions regrowing after radiosurgery. J Neurooncol. 2013;113(3):495–503.)).
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Neurosurgical laser ablation is a relatively new but rapidly growing application of [[stereotactic neurosurgery]] that allows neurosurgeons to treat many previously untreatable conditions with the added benefit of shorter hospitalizations and recovery times. The vast majority of these procedures, however, are performed using a multisite workflow pattern involving transport of the patient between the operating room (OR), the computed tomography (CT) suite, and the magnetic resonance imaging (MRI) suite, often necessitating patient transfer through public pathways and requiring multiple trips if laser fiber placement is not accurate. There are significant risks posed to the patient with this practice and no existing guidelines addressing it
((Larson PS, Vadivelu S, Azmi-Ghadimi H, Nichols A, Fauerbach L, Johnson HB.
Neurosurgical laser ablation and MR thermometry: Risks of multisite workflow
pattern. J Healthc Risk Manag. 2017 Apr;36(4):7-18. doi: 10.1002/jhrm.21258.
PubMed PMID: 28415147.
)).
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Laser ablation is an emerging, [[minimally invasive]] [[treatment]] for selected children with intractable [[focal epilepsy]] with improved procedural morbidity. Data for children lag similar studies in adults, but the hope is for near-equivalent seizure-control rates and improved neuropsychological outcome when compared with standard open surgical resection. The approach seems particularly beneficial when dealing with deep, focal lesions, such as [[hypothalamic hamartoma]]s or hippocampal sclerosis
((Buckley R, Estronza-Ojeda S, Ojemann JG. Laser Ablation in Pediatric Epilepsy.
Neurosurg Clin N Am. 2016 Jan;27(1):69-78. doi: 10.1016/j.nec.2015.08.006. Epub
2015 Oct 24. Review. PubMed PMID: 26615109.
)).

The [[NeuroBlate]] System (formerly known as the AutoLITT® System) applies focused [[laser]] energy to ablate brain tumors from the inside, with little or no effect on surrounding healthy tissue. NeuroBlate provides clinicians a new neurosurgical tool that offers real-time control and visualization of the therapy during [[laser ablation]] treatment. The NeuroBlate procedure is currently one of the only laser ablation neurosurgical procedures done in an active MRI magnet.


===== Indications =====

[[Magnetic resonance image-guided laser interstitial thermal therapy Indications]].

===== Case series =====

===== 2020 =====
[[Patient]]s with [[Glioblastoma]] who received concurrent [[LITT]] and surgical [[resection]] at the Department of Neurosurgery, University of [[Texas]] MD Anderson Cancer Center, [[Houston]] were identified. Patient demographic and clinical information was procured from the University of Texas MD Anderson Cancer Center [[electronic medical record]] along with [[preoperative]], [[postoperative]], and 1-month follow-up [[magnetic resonance imaging]] (MRI).

Four patients (n = 2 male, n = 2 female) with [[Glioblastoma IDH wildtype]] who received combined LITT and surgical resection were identified and analyzed [[retrospective]]ly. All patients received [[chemoradiotherapy]] before the presentation. All but one patient (75%) received resection before the presentation. The median age was 54 years (range: 44-56 years). The median length of [[hospital stay]] was 6.5 days (range: 2-47 days). The median extent of combined [[ablation]]/[[resection]] was 90.4%. One of the four patients experienced [[complication]]s in the perioperative or immediate follow-up periods. Local [[recurrence]] was observed in one patient during the follow-up period.

[[Malignant glioma]]s in deep-seated locations or in close proximity to [[white matter]] structures are challenging to manage. LITT followed by surgical resection may provide an alternative for tumor [[debulking]] that minimizes potential morbidities and extent of residual tumor. Further studies comparing this approach with standard resection techniques are warranted
((Vega RA, Traylor JI, Patel R, Muir M, Bastos DCA, Prabhu SS. Combined Surgical
Resection and Laser Interstitial Thermal Therapy for Glioblastoma: Technical
Note. J Neurol Surg A Cent Eur Neurosurg. 2020 May 3. doi:
10.1055/s-0040-1709163. [Epub ahead of print] PubMed PMID: 32361984.
)).