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Laser Ablation of Abnormal Neurological Tissue Using Robotic NeuroBlate System (LAANTERN): 12-Month Outcomes and Quality of Life After Brain Tumor Ablation
摘要： Laser Ablation of Abnormal Neurological Tissue using Robotic NeuroBlate System (LAANTERN) is an ongoing multicenter prospective NeuroBlate (Monteris Medical) LITT (laser interstitial thermal therapy) registry collecting real-world outcomes and quality-of-life (QoL) data. To compare 12-mo outcomes from all subjects undergoing LITT for intracranial tumors/neoplasms. Demographics, intraprocedural data, adverse events, QoL, hospitalizations, health economics, and survival data are collected; standard data management and monitoring occur. A total of 14 centers enrolled 223 subjects; the median follow-up was 223 d. There were 119 (53.4%) females and 104 (46.6%) males. The median age was 54.3 yr (range 3-86) and 72.6% had at least 1 baseline comorbidity. The median baseline Karnofsky Performance Score (KPS) was 90. Of the ablated tumors, 131 were primary and 92 were metastatic. Most patients with primary tumors had high-grade gliomas (80.9%). Patients with metastatic cancer had recurrence (50.6%) or radiation necrosis (40%). The median postprocedure hospital stay was 33.4 h (12.7-733.4). The 1-yr estimated survival rate was 73%, and this was not impacted by disease etiology. Patient-reported QoL as assessed by the Functional Assessment of Cancer Therapy-Brain was stabilized postprocedure. KPS declined by an average of 5.7 to 10.5 points postprocedure; however, 50.5% had stabilized/improved KPS at 6 mo. There were no significant differences in KPS or QoL between patients with metastatic vs primary tumors. Results from the ongoing LAANTERN registry demonstrate that LITT stabilizes and improves QoL from baseline levels in a malignant brain tumor patient population with high rates of comorbidities. Overall survival was better than anticipated for a real-world registry and comparative to published literature.
关键词： Brain tumor,Laser ablation,Quality of life,LITT,Survival
更新于2025-09-23 15:19:57
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National Trends and Factors Predicting Outcomes Following Laser Interstitial Thermal Therapy for Brain Lesions: Nationwide Inpatient Sample Analysis
摘要： Introduction: Laser interstitial thermal therapy (LITT) is a stereotactic-guided technique, which is increasingly being performed for brain lesions. The aim of our study was to report the national trends and factors predicting the clinical outcomes following LITT using the Nationwide Inpatient Sample (NIS). Methods: We extracted data from 2011-2016 using ICD-9/10 codes. Patients with a primary procedure of LITT were included. Patient demographics, complications, length of hospital stay (LOS), discharge disposition and index-hospitalization charges were analyzed. Results: A cohort of 1768 patients was identified from the database. Mean LOS was 3.2 days, 82% of patients were discharged to home and in-hospitalization cost was $124,225. Complications and mortality were noted in 12.9% and 2.5% of patients following LITT, respectively. Non-Caucasian patients (ER 4.26), those with other insurance (compared to commercial, ER: 5.35), 3 and 4+ comorbidity indexes, patients with higher quartile median household income (2nd, 3rd and 4th quartile compared to first quartile) and those who underwent non-elective procedures were likely to have higher complications and less likely to be discharged home. Patients with 4+ comorbidity indexes were likely to have longer LOS (ER 1.39), higher complications (ER: 7.95), less likely to be discharged home (ER: 0.17) and higher in-hospitalization cost (ER: 1.21). Conclusion: LITT is increasingly being performed with low complication rates. Non-Caucasian race, higher comorbidity index, non-commercial insurance and non-elective procedures were predictors of higher complications and less likely to be discharged home. In-hospitalization charges were higher in patients with higher comorbidity index and those with non-commercial insurance.
关键词： LITT,nationwide inpatient sample,outcomes,National trends
更新于2025-09-19 17:13:59
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Laser interstitial thermal therapy for pediatric atypical teratoid/rhabdoid tumor: case report
摘要： Herein, the authors describe the successful use of laser interstitial thermal therapy (LITT) for management of metastatic craniospinal disease for biopsy-proven atypical teratoid/rhabdoid tumor in a 16-month-old boy presenting to their care. Specifically, LITT was administered to lesions of the right insula and left caudate. The patient tolerated 2 stages of LITT to the aforementioned lesions without complication and with evidence of radiographic improvement of lesions at the 2- and 6-month follow-up appointments. To the authors’ knowledge, this represents the first such published report of LITT for management of atypical teratoid/rhabdoid tumor.
关键词： laser interstitial thermal therapy,ATRT,atypical teratoid/rhabdoid tumor,pediatric brain tumor,LITT
更新于2025-09-19 17:13:59
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Laser Interstitial Thermal Therapy for Metastatic Melanoma After Failed Radiation Therapy: A Case Series
摘要： Laser interstitial thermal therapy (LITT) is a growing technology to treat a variety of brain lesions. It offers an alternative to treatment options, such as open craniotomy and stereotactic radiosurgery. OBJECTIVE: To analyze our experience using LITT for metastatic melanoma. METHODS: This is a retrospective chart review of the patients from our institution. Our case series involves 5 patients who had previously failed radiation treatment. RESULTS: Our patients have low complication rates and short hospital stays. Both are considerably lower when compared to the literature for metastatic melanoma. CONCLUSION: LITT is a safe therapy, with few complications and short hospital stays.
关键词： Melanoma,LITT,Laser interstitial thermal therapy
更新于2025-09-19 17:13:59
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Laser interstitial thermal therapy
摘要： Background. Laser interstitial thermal therapy (LITT) is becoming an increasingly popular technique for the treatment of brain lesions. More minimally invasive that open craniotomy for lesion resection, LITT may be more appropriate for lesions that are harder to access through an open approach, deeper lesions, and for patients who may not tolerate open surgery. Methods. A search of the current primary literature on LITT for brain lesions on PubMed was performed. These studies were reviewed and updates on the radiological, pathological, and long-term outcomes after LITT for brain metastases, primary brain tumors, and radiation necrosis as well as common complications are included. Results. Larger extent of ablation and LITT as frontline treatment were potential predictors of favorable progression-free and overall survival for primary brain tumors. In brain metastases, larger extent of ablation was more significantly associated with survival benefit, whereas tumor size was a possible predictor. The most common complications after LITT are transient and permanent weakness, cerebral edema, hemorrhage, seizures, and hyponatremia. Conclusions. Although the current literature is limited by small sample sizes and primarily retrospective studies, LITT is a safe and effective treatment for brain lesions in the correct patient population.
关键词： brain tumor,brain metastasis,LITT
更新于2025-09-19 17:13:59
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Laser interstitial thermal therapy (LITT) of the brain – Experiences and new indications
摘要： The glioma is the most common type of primary brain tumor; more than 40% of gliomas are malignant. For decades, open microsurgical resection and postoperative radiochemotherapy have been the international standard methods of treatment. During the last few years, the importance of the (sub-)total tumor resection has been recognized, especially in respect of the patient’s progression-free survival time. Different modalities of neuronavigation, intraoperative imaging (“open MR” system) and intraoperative fluoroscopy with 5-ALA have proved to be important technical achievements to support this aim. However, the overall survival time of patients with anaplastic gliomas is poor. Successful curative treatments are statistically insignificant. As a result, it was and still is important to find new adjuvant methods to treat (recurrent) brain tumors. One of the most promising minimally invasive procedures is the laser interstitial thermal therapy (LITT), performed under stereotactic or “open” magnetic resonance imaging (MRI) guidance.
关键词： brain tumors,minimally invasive,Laser interstitial thermal therapy,gliomas,LITT
更新于2025-09-16 10:30:52
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Predictors of Local Control of Brain Metastasis Treated With Laser Interstitial Thermal Therapy
摘要： BACKGROUND: Laser Interstitial Thermal Therapy (LITT) has been used to treat recurrent brain metastasis after stereotactic radiosurgery (SRS). Little is known about how best to assess the efficacy of treatment, specifically the ability of LITT to control local tumor progression post-SRS. OBJECTIVE: To evaluate the predictive factors associated with local recurrence after LITT. METHODS: Retrospective study with consecutive patients with brain metastases treated with LITT. Based on radiological aspects, lesions were divided into progressive disease after SRS (recurrence or radiation necrosis) and new lesions. Primary endpoint was time to local recurrence. RESULTS: A total of 61 consecutive patients with 82 lesions (5 newly diagnosed, 46 recurrence, and 31 radiation necrosis). Freedom from local recurrence at 6 mo was 69.6%, 59.4% at 12, and 54.7% at 18 and 24 mo. Incompletely ablated lesions had a shorter median time for local recurrence (P < .001). Larger lesions (>6 cc) had shorter time for local recurrence (P = .03). Dural-based lesions showed a shorter time to local recurrence (P = .01). Tumor recurrence/newly diagnosed had shorter time to local recurrence when compared to RN lesions (P = .01). Patients receiving systemic therapy after LITT had longer time to local recurrence (P = .01). In multivariate Cox-regression model, the HR for incomplete ablated lesions was 4.88 (P < .001), 3.12 (P = .03) for recurrent tumors, and 2.56 (P = .02) for patients not receiving systemic therapy after LITT. Complication rate was 26.2%. CONCLUSION: Incompletely ablated and recurrent tumoral lesions were associated with higher risk of treatment failure and were the major predicting factors for local recurrence. Systemic therapy after LITT was a protective factor regarding local recurrence.
关键词： LITT,Brain metastasis,Radiation necrosis,Stereotactic radiosurgery
更新于2025-09-12 10:27:22
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Pediatric Neurosurgery: Tricks of the Trade || 104 Laser Ablation of Deep Lesions
摘要： A major goal of neurosurgical management of many deep lesions is to safely destroy, or neutralize the consequences of, a lesion without damage to nearby structures. “Neutralization” here means to render harmless, as in cases where deep lesions cause seizures, such as hypothalamic hamartomas or lesions of the hippocampus. A stereotactic procedure that minimally disrupts other tissue and avoids the long-term effects of ionizing radiation (as with stereotactic radiosurgery [SRS]) may prove to be the strategy of choice. For the technique described in this chapter, laser interstitial thermoablative therapy (LITT), the key additional safety element is the ability to observe the anatomical boundaries and progress of the laser lesion as it is being made. Since the procedure is performed “closed” through a twist-drill hole, the visualization of the lesion is effected using real-time magnetic resonance imaging (MRI) observation of the target—and automated control of the laser to turn the power off when specific criteria are met. Many of the nuances of the procedure therefore depend on an understanding of the underlying phenomena and on the ability to interact with the stereotactic and laser control software.
关键词： Deep Lesions,Laser Ablation,Neurosurgical Management,LITT,MRI
更新于2025-09-12 10:27:22
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Anatomic and Thermometric Analysis of Cranial Nerve Palsy after Laser Amygdalohippocampotomy for Mesial Temporal Lobe Epilepsy
摘要： BACKGROUND: Laser interstitial thermal therapy (LITT) is a minimally invasive therapy for treating medication-resistant mesial temporal lobe epilepsy. Cranial nerve (CN) palsy has been reported as a procedural complication, but the mechanism of this complication is not understood. OBJECTIVE: To identify the cause of postoperative CN palsy after LITT. METHODS: Four medial temporal lobe epilepsy patients with CN palsy after LITT were identified for comparison with 22 consecutive patients with no palsy. We evaluated individual variation in the distance between CN III and the uncus, and CN IV and the parahippocampal gyrus using preoperative T1- and T2-weighted magnetic resonance (MR) images. Intraoperative MR thermometry was used to estimate temperature changes. RESULTS: CN III (n = 2) and CN IV palsies (n = 2) were reported. On preoperative imaging, the majority of identified CN III (54%) and CN IV (43%) were located within 1 to 2 mm of the uncus and parahippocampal gyrus tissue border, respectively. Affected CN III and CN IV were more likely to be found < 1 mm of the tissue border (PCNIII = .03, PCNIV < .01; chi-squared test). Retrospective assessment of thermal profile during ablation showed higher temperature rise along the mesial temporal lobe tissue border in affected CNs than unaffected CNs after controlling for distance (12.9?C vs 5.8?C; P = .03; 2-sample t-test). CONCLUSION: CN palsy after LITT likely results from direct heating of the respective CN running at extreme proximity to the mesial temporal lobe. Low-temperature thresholds set at the border of the mesial temporal lobe in patients whose CNs are at close proximity may reduce this risk.
关键词： LITT,MR thermometry,Mesial temporal lobe epilepsy,Laser amygdalohippocampotomy,Cranial nerve palsy
更新于2025-09-12 10:27:22
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Understanding the Relationship Between Real-Time Thermal Imaging and Thermal Damage Estimate During Magnetic Resonance–Guided Laser Interstitial Thermal Therapy
摘要： Objectives: Magnetic Resonance-guided Laser Interstitial Thermal Therapy (MRgLITT) is a minimally invasive procedure that utilizes intraoperative magnetic resonance thermometry (MRT) to generate a thermal damage estimate (TDE) of the ablative area. This study compared areas produced by the MRT heat map to the system-generated TDE produced by the Visualase software. Methods: All ablations were performed using the Visualase MRI-Guided Laser Ablation System. MRT heat-map and TDE were quantified using MATLAB version R2014a. The TDE was compared to the summed area of the green, yellow, and red areas (HM63.9) and the summed area of the light blue, green, yellow, and red areas (HM50.4) produced by the MRT heat map. Results: 56 patients undergoing MRgLITT were examined. The mean TDE produced was 236 mm2 (SEM = 9.5). The mean HM63.9 was 231 mm2 (SEM = 8.7), and the mean HM50.4 was 370 mm2 (SEM = 12.8). There was no significant difference between the TDE and HM63.9 (p = 0.51) . There was a significant difference between TDE and HM50.4 (p < 0.001) and between HM63.9 and HM50.4 (p < 0.001). Conclusions: The system-generated TDE consistently remains contained within the boundaries of the MRT heat map. At standard factory settings, the TDE and the area produced within the periphery of the HM63.9 are similar in magnitude. The light blue portion of the MRT heat map may serve as an additional means of predicting when critical structures may be at risk during laser ablation if exposed to further thermal stress.
关键词： MRTI,Thermal ablation parameters,LITT,Laser interstitial thermal therapy,Magnetic resonance thermometry
更新于2025-09-11 14:15:04