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  • Laser Interstitial Thermal Therapy for Inoperable Brain Tumors of the Thalamus

    Final Number:
    1556

    Authors:
    Roger Murayi MD; Hamid Borghei-Razavi MD, PhD; Bryan S Lee MD; Gene H. Barnett MD; Alireza M Mohammadi MD

    Study Design:
    Other

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2018 Annual Meeting

    Introduction: Open surgery on brain tumors of the thalamus carries an unacceptable level of morbidity and mortality. Laser Interstitial Thermal Therapy (LITT) offers a minimally-invasive, surgical option for ablation of these tumors. LITT uses focused, laser-induced tissue hyperthermia to deep brain tumors via a small probe inserted stereotactically. A side-firing, CO2 cooled, fiberoptic catheter heats the surrounding tissue above 43 Celsius which is monitored via MRI thermometry in real time. Surgical “ablation” is thus achieved. We report on our experience with LITT on 13 patients with thalamic brain tumors at our institution.

    Methods: A retrospective analysis was conducted of 13 patients who received LITT for thalamic neoplasms at our institution. Preoperative and postoperative (1-3 months) tumor size, post-operative hospital length of stay, and complications were assessed across all patients.

    Results: 13 patients treated at our institution from 2012 to 2017 were analyzed. 11 had high grade gliomas (WHO III-IV) and 2 had metastases (breast cancer and non-small cell cancer). Mean hospital stay was 5.5 days post-operatively. Mean pre-operative tumor size was 12 cubic centimeters and decreased on average by 42.9% at the 1-3 month MRI. Average thermal damage threshold (TDT) coverage was 96.4% (SD 4.21) at the yellow line (43C x 2 minutes) and 92.8% (SD 5.73) at the blue line (43C for 10 minutes). Post-op complications occurred in 4 patients including 3 patients with intracerebral hemorrhage (ICH). 2 of these died in the immediate post-operative period. The last patient developed hydrocephalus requiring an external ventricular drain then shunt. Only increased estimated blood loss was significantly different in the two patients who died.

    Conclusions: In our experience, LITT is a feasible surgical option for thalamic tumors. In 13 patients, tumor size decreased significantly by 1-3 month follow-up. There were however 2 deaths in the immediate post-operative period secondary to ICH.

    Patient Care: By offering a surgical option to patients with otherwise inoperable tumors of the thalamus

    Learning Objectives: 1) Laser interstitial thermal therapy is a feasible surgical option for thalamic tumors 2) Pertinent complications include ICH and shunt dependence

    References:

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