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Magnetic Resonance Thermometry-Guided Laser-Induced Thermal Therapy for Intracranial Neoplasms: Initial Experience

Jethwa, Pinakin R. MD*; Barrese, James C. MD*; Gowda, Ashok PhD; Shetty, Anil MBBS, ME; Danish, Shabbar F. MD§

Neurosurgery:
doi: 10.1227/NEU.0b013e31826101d4
Technique Assessment
Abstract

BACKGROUND: Laser-induced thermal therapy is a promising tool in the neurosurgeon's armamentarium. This methodology has seen a resurgence in application as a result of advances in technology.

OBJECTIVE: To report our initial experience with the procedure after treating 20 consecutive patients, the largest series to date.

METHODS: Patients were selected for laser therapy if they had failed conventional therapies, were unable to tolerate an open cranial procedure, or the tumor was deemed otherwise inoperable. In this series, 980-nm diode laser catheters were placed stereotactically in the operating room. The patients were then transferred to the magnetic resonance imaging suite for thermal ablation.

RESULTS: A total of 31 laser applicators were placed in 20 patients with intracranial neoplasms. The majority of patients (17 of 20) had prior treatment for their tumors. The overall accuracy of laser insertion was 83.9%, improving with increased experience. The average lesion volume treated was 7.0 ± 9.0 cm3. With the use of damage estimates from the software provided, the treatment continued until the entire tumor had been irreversibly ablated. The average length of hospitalization was 2.27 days, with the majority of patients going home on postoperative day 1. Complications occurred in 4 patients, typically in those who were in poor health preoperatively.

CONCLUSION: Laser-induced thermal therapy is an intuitive procedure for treating difficult intracranial neoplasms. As with any other procedure, patient selection and lesion selection are important factors in determining outcome.

ABBREVIATIONS: LITT, laser-induced thermal therapy

Nd:YAG, neodymium-doped yttrium aluminum garnet

PAD, precision aiming device

Author Information

*Department of Neurosurgery, UMDNJ--New Jersey Medical School, Newark, New Jersey

Visualase Inc, Houston, Texas

§Division of Neurosurgery, UMDNJ-- Robert Wood Johnson Medical School, New Brunswick, New Jersey

Correspondence: Pinakin R. Jethwa, MD, UMDNJ - New Jersey Medical School, Department of Neurological Surgery, 125 Paterson St. CAB Suite 2100, New Brunswick, NJ 08901. E-mail: pinakin.jethwa.md@gmail.com

Received January 25, 2012

Accepted May 9, 2012

Copyright © by the Congress of Neurological Surgeons