Introduction: Stereotactic laser ablation (SLA) is an innovative minimally invasive strategy used to treat intracranial tumors. While it is applied commonly in adults as adjuvant therapy for high grade tumors, its use in children is less well understood. At Texas Children’s
Hospital (TCH), an interdisciplinary team considers SLA, with or without concomitant biopsy, as a diagnostic and treatment strategy in select cases. This study represents our institutional experience over 5 years using SLA for children with brain tumors.
Methods: A retrospective chart review was performed for patients less than 18 years old undergoing SLA at TCH from 2012-2016. Demographics, medical history, and surgical outcomes were recorded. Biopsy diagnosis rate, adjuvant treatments, and tumor outcomes are noted.
Results: Fourteen children (7 males), with an average age at first surgery of 11.6 years, underwent SLA for WHO I (8), WHO II (1), WHO III (1), WHO IV (2) and unknown (2) tumors. Tumor locations were deep (periventricular, midbrain) in nine cases. Antecedent biopsy was diagnostic in 5 of the 7 patients (71%). SLA without concurrent biopsy was the solo treatment in the other 7 patients (50%). Complete ablation of tumors was confirmed radiographically in 11/14 children. Follow-up time was an average of 2 years. At follow up, 11 children had stable disease, 2 had recurrences, and there was 1 death. One patient developed acute postoperative hydrocephalus requiring temporary ventricular drain placement for cerebrospinal fluid diversion.
Conclusions: SLA is an effective novel adjunctive or primary treatment modality for primary brain tumors in children, with a low complication profile, even in deep locations, and may be easily paired with diagnostic biopsy.
Patient Care: Laser ablation provides a method of treatment for tumors which are not candidates for surgery, due to location or surgical morbidity. It has the potential to treat lesions with less associated morbidity and mortality than open craniotomy.
Learning Objectives: 1. Laser ablation has been effective in adult brain tumors (metastases and primary lesions)
2. Laser ablation is increasing in use in the pediatric population
3. Laser ablation is safe and effective in pediatric tumors