Introduction: As the lifespan of patients with cerebral metastases improves, recurrence after whole brain radiation and stereotactic radiosurgery is more common. Laser interstitial thermal therapy (LITT) is a new minimally invasive technique that destroys tissue through the administration of heat and can be used to treat lesions in locations undesirable for open surgery. A CO2-cooled YAG laser that fires perpendicular to the laser-delivery catheter is introduced through a burr hole using stereotactic guidance and used to provide thermal energy to ablate the lesion. LITT is monitored with real-time magnetic resonance imaging (MRI) thermometry and software is available to sum the regions heated sufficiently to achieve thermal ablation.
Methods: We describe LITT on five patients with enlarging enhancing lesions at the site of cerebral metastases that had been previously treated with Gamma Knife (GK). Patients were taken to the operating room for fixation of an MRI-compatible guide (Monteris Medical, Axiis) to the skull and a stereotactic brain biopsy. Following the biopsy, patients had LITT to the lesion in the MRI suite.
Results: One biopsy demonstrated metastatic carcinoma. Pathology from four of the five biopsies was consistent with radiation necrosis rather than tumor recurrence. Three patients did well post-treatment without complications. One patient had wound infection requiring readmission. One patient had a hemorrhage at the biopsy site resulting in worsening hemiparesis and aphasia both of which have largely but not completely resolved with therapy. Follow-up imaging shows obliteration of the lesion in all five instances.
Conclusions: LITT is a minimally invasive neurosurgical technique that can be used for the treatment of recurrent brain metastases or radiation necrosis in patients who are poor candidates for conventional surgery because of the location of the lesion.
Patient Care: This study investigates the use of laser thermotherapy in treating patients with recurrent cerebral metastases. As these patients continue to live longer, treatment of recurrence needs to be addressed by neurosurgeons more frequently. Laser thermotherapy is a new minimally invasive technique that may improve recurrence rates and ultimately improve quality and length of life for these patients.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) describe the technique of laser thermotherapy and how it can be utilized for treatment of intracranial lesions 2)compare and contrast the use of laser thermotherapy to other conventional neurosurgical interventions (i.e. surgery, SRS) 3) discuss treatment algorithms for patients with recurrent cerebral metastases