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Gecici NN, Gurses ME, Kaye B, Jimenez NLF, Berke C, Gökalp E, Lu VM, Ivan ME, Komotar RJ, Shah AH. Comparative analysis of bevacizumab and LITT for treating radiation necrosis in previously radiated CNS neoplasms: a systematic review and meta-analysis. J Neurooncol 2024; 168:1-11. [PMID: 38619777 PMCID: PMC11093788 DOI: 10.1007/s11060-024-04650-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 03/15/2024] [Indexed: 04/16/2024]
Abstract
PURPOSE Radiation necrosis (RN) is a local inflammatory reaction that arises in response to radiation injury and may cause significant morbidity. This study aims to evaluate and compare the efficacy of bevacizumab and laser interstitial thermal therapy (LITT) in treating RN in patients with previously radiated central nervous system (CNS) neoplasms. METHODS PubMed, Cochrane, Scopus, and EMBASE databases were screened. Studies of patients with radiation necrosis from primary or secondary brain tumors were included. Indirect meta-analysis with random-effect modeling was performed to compare clinical and radiological outcomes. RESULTS Twenty-four studies were included with 210 patients in the bevacizumab group and 337 patients in the LITT group. Bevacizumab demonstrated symptomatic improvement/stability in 87.7% of cases, radiological improvement/stability in 86.2%, and steroid wean-off in 45%. LITT exhibited symptomatic improvement/stability in 71.2%, radiological improvement/stability in 64.7%, and steroid wean-off in 62.4%. Comparative analysis revealed statistically significant differences favoring bevacizumab in symptomatic improvement/stability (p = 0.02), while no significant differences were observed in radiological improvement/stability (p = 0.27) or steroid wean-off (p = 0.90). The rates of adverse reactions were 11.2% for bevacizumab and 14.9% for LITT (p = 0.66), with the majority being grade 2 or lower (72.2% for bevacizumab and 62.5% for LITT). CONCLUSION Both bevacizumab and LITT exhibited favorable clinical and radiological outcomes in managing RN. Bevacizumab was found to be associated with better symptomatic control compared to LITT. Patient-, diagnosis- and lesion-related factors should be considered when choosing the ideal treatment modality for RN to enhance overall patient outcomes.
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Affiliation(s)
- Neslihan Nisa Gecici
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, 33136, US
| | - Muhammet Enes Gurses
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, 33136, US.
| | - Brandon Kaye
- Dr. Kiran C. Patel College of Allopathic Medicine, Davie, FL, 33326, US
| | | | - Chandler Berke
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, 33136, US
| | - Elif Gökalp
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, 33136, US
| | - Victor M Lu
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, 33136, US
| | - Michael E Ivan
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, 33136, US
| | - Ricardo J Komotar
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, 33136, US
| | - Ashish H Shah
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, 33136, US
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Luther E, Ramsay I, Berke C, Makhoul V, Lu V, Elarjani T, Burks J, Berry K, Eichberg DG, Di L, Mansour S, Echeverry N, Morell A, Ivan M, Komotar R. Widening the Operative Corridor-Evaluating the Transcortical Approach to Giant Falcine Meningiomas. World Neurosurg 2024; 185:e442-e450. [PMID: 38364894 DOI: 10.1016/j.wneu.2024.02.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND Giant falcine meningiomas are surgically complex as they are deep in location, concealed by normal brain parenchyma, in close proximity to various neurovascular structures, and frequently involve the falx bilaterally. Although classically accessed using a bifrontal craniotomy and interhemispheric approach, little data exist on alternative operative corridors for these challenging tumors. We evaluated perioperative and long-term outcomes in patients undergoing transcortical resection of giant bilateral falcine meningiomas. METHODS From 2013 to 2022, fourteen patients with giant bilateral falcine meningiomas treated via a transcortical approach at our institution were identified. Perioperative and long-term outcomes were evaluated to determine predictors of adverse events. Corticectomy depth was also analyzed to determine if it correlated with increased postoperative seizure rates. RESULTS 57.1% of cases were WHO grade 2 meningiomas. Average tumor volume was 77.8 ± 46.5 cm3 and near/gross total resection was achieved in 78.6% of patients. No patient developed a venous infarct or had seizures in the 6 months after surgery. Average corticectomy depth was 0.83 ± 0.71 cm and increasing corticectomy depth did not correlate with higher risk of postoperative seizures (P = 0.44). Increasing extent of tumor resection correlated with lower tumor grade (P = 0.011) and only 1 patient required repeat resection during a median follow-period of 24.9 months. CONCLUSIONS The transcortical approach is a safe alternative corridor for accessing giant, falcine meningiomas, and postoperative seizures were not found to correlate with increasing corticectomy depth. Further prospective studies are necessary to determine the best approach to these surgically complex lesions.
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Affiliation(s)
- Evan Luther
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
| | - Ian Ramsay
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Chandler Berke
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Vivien Makhoul
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Victor Lu
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Turki Elarjani
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Joshua Burks
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Katherine Berry
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Daniel G Eichberg
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Long Di
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Samuel Mansour
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Nikolas Echeverry
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Alexis Morell
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Michael Ivan
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA; Sylvester Comprehensive Cancer Center, University of Miami Health System, Miami, Florida, USA
| | - Ricardo Komotar
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA; Sylvester Comprehensive Cancer Center, University of Miami Health System, Miami, Florida, USA
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Cuschieri A, Borg M, Levinskaia E, Zammit C. LITT for biopsy proven radiation necrosis: A qualitative systematic review. J Clin Neurosci 2023; 116:69-78. [PMID: 37639807 DOI: 10.1016/j.jocn.2023.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/18/2023] [Accepted: 08/19/2023] [Indexed: 08/31/2023]
Abstract
INTRODUCTION With the widespread use of stereotactic radiosurgery (SRS), post-radiation treatment effects (PTREs) are increasing in prevalence. Radiation necrosis (RN) is a serious PTRE which carries a poor prognosis. Since 2012, laser interstitial thermal therapy (LITT) has been used to treat RN. However, reviews have attempting to generalise the efficacy of LITT against biopsy-proven RN are limited. In this systematic review, patient demographic characteristics and post-LITT clinical outcomes are characterised. METHODS A systematic literature search was conducted in four major databases for cohort studies and case reports published between 2012 and 2022, following the PRISMA 2020 checklist. Data was extracted and descriptively analysed. Quality of reporting was assessed using the PROCESS criteria and reporting bias was evaluated using the ROBINS-I scoring system. RESULTS Eleven studies met our inclusion criteria, with an overall moderate risk of reporting bias being observed. Mean pre-LITT target lesion volume was 6.75 cm3, and was independent of gender, time since SRS, age and number of interventions prior to LITT. DISCUSSION AND CONCLUSION LITT is a versatile treatment option which may be used to treat a vast range of patients with refractory biopsy-proven RN. However, neurosurgeons should exercise caution when selecting patients for LITT due to insufficient data on the treatment's efficacy against biopsy-proven RN. This warrants further studies to unequivocally determine the safety and clinical outcomes.
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Affiliation(s)
- Andrea Cuschieri
- Faculty of Medicine and Surgery, University of Malta, Imsida MSD2080, Malta.
| | - Mariah Borg
- Faculty of Medicine and Surgery, University of Malta, Imsida MSD2080, Malta
| | | | - Christian Zammit
- Faculty of Medicine and Surgery, University of Malta, Imsida MSD2080, Malta
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Baskaran AB, Buerki RA, Khan OH, Gondi V, Stupp R, Lukas RV, Villaflor VM. Building Team Medicine in the Management of CNS Metastases. J Clin Med 2023; 12:3901. [PMID: 37373596 DOI: 10.3390/jcm12123901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/30/2023] [Accepted: 06/03/2023] [Indexed: 06/29/2023] Open
Abstract
CNS metastases are often terminal for cancer patients and occur at an approximately 10-fold higher rate than primary CNS tumors. The incidence of these tumors is approximately 70,000-400,000 cases annually in the US. Advances that have occurred over the past two decades have led to more personalized treatment approaches. Newer surgical and radiation techniques, as well as targeted and immune therapies, have enanled patient to live longer, thus increasing the risk for the development of CNS, brain, and leptomeningeal metastases (BM and LM). Patients who develop CNS metastases have often been heavily treated, and options for future treatment could best be addressed by multidisciplinary teams. Studies have indicated that patients with brain metastases have improved survival outcomes when cared for in high-volume academic institutions using multidisciplinary teams. This manuscript discusses a multidisciplinary approach for both parenchymal brain metastases as well as leptomeningeal metastases implemented in three academic institutions. Additionally, with the increasing development of healthcare systems, we discuss optimizing the management of CNS metastases across healthcare systems and integrating basic and translational science into our clinical care to further improve outcomes. This paper summarizes the existing therapeutic approaches to the treatment of BM and LM and discusses novel and emerging approaches to optimizing access to neuro-oncologic care while simultaneously integrating multidisciplinary teams in the care of patients with BM and LM.
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Affiliation(s)
- Archit B Baskaran
- Department of Neurology, The University of Chicago, Chicago, IL 60637, USA
| | - Robin A Buerki
- Health System Clinician of Neurology (Neuro-Oncology), Northwestern Medicine Regional Medical Group, Warrenville, IL 60555, USA
| | - Osaama H Khan
- Surgical Neuro-Oncology, Northwestern Medicine Central DuPage Hospital, Winfield, IL 60190, USA
| | - Vinai Gondi
- Department of Radiation Oncology, Nothwestern Medicine West Region, Lou & Jean Malnati Brain Tumor Institute, Northwestern University, Warrenville, IL 60555, USA
| | - Roger Stupp
- Neuro-Oncology Division, Neurological Surgery, Medicine (Hematology and Oncology), Neurology, Department of Neurology, Lou & Jean Malnati Brain Tumor Institute Northwestern University, Chicago, IL 60611, USA
| | - Rimas V Lukas
- Neuro-Oncology Division, Department of Neurology, Lou & Jean Malnati Brain Tumor Institute, Northwestern University, Chicago, IL 60611, USA
| | - Victoria M Villaflor
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA
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Porter AB. Neurologic Complications of Cancer Treatment. Continuum (Minneap Minn) 2023; 29:903-922. [PMID: 37341335 DOI: 10.1212/con.0000000000001236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
OBJECTIVE Advances in cancer treatment have led to extended survival and increased risk of neurologic complications in an aging population. This review summarizes potential neurologic complications in patients who have undergone treatment for neurologic and systemic malignancies. LATEST DEVELOPMENTS Radiation and cytotoxic chemotherapy along with other targeted therapies continue to be the mainstay of cancer treatment. These advances in cancer care have led to improved outcomes and increased the need to understand the spectrum of neurologic complications that may arise from treatment. While radiation and older therapies including cytotoxic chemotherapies have side effect profiles that are widely known and well understood, this article serves as a review of the more commonly associated neurologic complications of both traditional and newer treatments being offered to this patient population. ESSENTIAL POINTS Neurotoxicity is a common complication of cancer-directed treatment. In general, neurologic complications of radiation therapy are more common in central nervous system malignancies, and neurologic complications of chemotherapy are more common in non-neurologic malignancies. Attempts at prevention, early detection, and intervention remain paramount in the reduction of neurologic morbidity.
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Peña-Pino I, Chen CC. Stereotactic Radiosurgery as Treatment for Brain Metastases: An Update. Asian J Neurosurg 2023; 18:246-257. [PMID: 37397044 PMCID: PMC10310446 DOI: 10.1055/s-0043-1769754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2023] Open
Abstract
Stereotactic radiosurgery (SRS) is a mainstay treatment option for brain metastasis (BM). While guidelines for SRS use have been outlined by professional societies, consideration of these guidelines should be weighed in the context of emerging literature, novel technology platforms, and contemporary treatment paradigms. Here, we review recent advances in prognostic scale development for SRS-treated BM patients and survival outcomes as a function of the number of BM and cumulative intracranial tumor volume. Focus is placed on the role of stereotactic laser thermal ablation in the management of BM that recur after SRS and the management of radiation necrosis. Neoadjuvant SRS prior to surgical resection as a means of minimizing leptomeningeal spread is also discussed.
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Affiliation(s)
- Isabela Peña-Pino
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, Minnesota, United States
| | - Clark C. Chen
- Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, United States
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7
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Merenzon MA, Patel NV, Morell AA, Marcó Del Pont F, Moll JM, Komotar RJ, Ivan ME. Newly Diagnosed Adult Basal Ganglia Gliomas Treated With Laser Interstitial Thermal Therapy: A Comparative Cohort With Needle Biopsy. Oper Neurosurg (Hagerstown) 2023; 24:383-390. [PMID: 36701559 DOI: 10.1227/ons.0000000000000553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 09/27/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Few cytoreductive surgical tools are available for newly diagnosed basal ganglia gliomas. Current reports showed high associated morbidity and mortality. Given their deep localization, laser interstitial thermal therapy (LITT) is still a rare indication. Moreover, few reports account for which of the available options have better outcomes. OBJECTIVE To retrospectively analyze our experience with LITT and compare its safety, feasibility, and efficacy with needle biopsy for the management of adult basal ganglia gliomas. METHODS Twenty-two patients with gliomas from the midline (e.g. thalamus and lenticular nucleus) managed with either LITT/biopsy or needle biopsy from 2015 to 2021 were included. Records regarding location, diagnosis, Karnofsky Performance Score, length of hospital stay, preoperative lesion and ablation volume, perioperative complications, and data of adjuvant treatment were collected. Overall survival was evaluated with Kaplan-Meier analysis. RESULTS Seven patients had LITT, and 15 underwent biopsy. The overall mean age was 60.9 years (25-82 years). The average tumor volume in the former was 16.99 cm 3 and 17.65 cm 3 in the latter. No postsurgical complications were found in the LITT group, and 1 patient had a postsurgical hemorrhage after biopsy. The mean overall survival was 20.28 ± 9.63 months in the LITT group, which was greater but not statistically significant than in the biopsy group (13.85 ± 4.48 months; P = .78). CONCLUSION Our results show that laser ablation may be both feasible and safe in adult basal ganglia gliomas. Given the lack of safe cytoreductive treatment options, LITT should be considered as a valid choice for these patients.
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Affiliation(s)
- Martín A Merenzon
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Nitesh V Patel
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Alexis A Morell
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Francisco Marcó Del Pont
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Joshua M Moll
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ricardo J Komotar
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Michael E Ivan
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, USA
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8
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Terrapon APR, Krüger M, Hundsberger T, Neidert MC, Bozinov O. Laser Interstitial Thermal Therapy for Radionecrosis. Neurosurg Clin N Am 2023; 34:209-225. [PMID: 36906328 DOI: 10.1016/j.nec.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Radiotherapy is widely used for brain tumors but can cause radiation necrosis (RN). Laser interstitial thermal therapy (LITT) is a relatively new therapeutic modality for RN and its impact on patient outcome is still not well understood. Based on a systematic literature search (n=33), the authors discuss the available evidence. Most studies found a positive safety/efficacy profile, as LITT may help to lengthen survival, prevent progression, taper steroids, and improve neurological symptoms while remaining safe. Prospective studies on this subject are needed and may result in LITT becoming an essential therapeutic option for the treatment of RN.
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Affiliation(s)
- Alexis Paul Romain Terrapon
- Department of Neurosurgery, Kantonsspital St. Gallen, Medical School St. Gallen, Rorschacher Strasse 95, St. Gallen 9007, Switzerland
| | - Marie Krüger
- Department of Neurosurgery, Kantonsspital St. Gallen, Medical School St. Gallen, Rorschacher Strasse 95, St. Gallen 9007, Switzerland; Unit of Functional Neurosurgery, Institute of Neurology and Neurosurgery, 33 Queen Square, London WC1N 3BG, UK; Department of Stereotactic and Functional Neurosurgery, University Medical Center Freiburg, Breisacher Strasse 64, Freiburg 79095, Germany
| | - Thomas Hundsberger
- Department of Neurology and of Oncology, Kantonsspital St. Gallen, Medical School St. Gallen, Rorschacher Strasse 95, St. Gallen 9007, Switzerland
| | - Marian Christoph Neidert
- Department of Neurosurgery, Kantonsspital St. Gallen, Medical School St. Gallen, Rorschacher Strasse 95, St. Gallen 9007, Switzerland
| | - Oliver Bozinov
- Department of Neurosurgery, Kantonsspital St. Gallen, Medical School St. Gallen, Rorschacher Strasse 95, St. Gallen 9007, Switzerland.
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9
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Damante MA, Wang JL, Elder JB. Surgical Management of Recurrent Brain Metastasis: A Systematic Review of Laser Interstitial Thermal Therapy. Cancers (Basel) 2022; 14:cancers14184367. [PMID: 36139527 PMCID: PMC9496803 DOI: 10.3390/cancers14184367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/01/2022] [Accepted: 09/06/2022] [Indexed: 11/16/2022] Open
Abstract
The incidence of recurrent metastatic brain tumors is increasing due to advances in local therapy, including surgical and radiosurgical management, as well as improved systemic disease control. The management of recurrent brain metastases was previously limited to open resection and/or irradiation. In recent years, laser interstitial thermal therapy (LITT) has become a promising treatment modality. As systemic and intracranial disease burden increases in a patient, patients may no longer be candidates for surgical resection. LITT offers a relatively minimally invasive option for patients that cannot tolerate or do not want open surgery, as well as an option for accessing deep-seated tumors that may be difficult to access via craniotomy. This manuscript aims to critically review the available data regarding the use of LITT for recurrent intracranial brain metastasis. Ten of seventy-two studies met the criteria for review. Generally, the available literature suggests that LITT is a safe and feasible option for the treatment of recurrent brain metastases involving supratentorial and cortical brain, as well as posterior fossa and deep-seated locations. Among all studies, only one directly compared craniotomy to LITT in the setting of recurrent brain metastasis. Prospective studies are needed to better elucidate the role of LITT in the management of recurrent brain metastases.
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Del Valle MM, Nduom EK, Olson J, Hoang KB. Commentary: Time to Steroid Independence After Laser Interstitial Thermal Therapy vs Medical Management for Treatment of Biopsy-Proven Radiation Necrosis Secondary to Stereotactic Radiosurgery for Brain Metastasis. Neurosurgery 2022; 90:e142-e143. [PMID: 35394474 DOI: 10.1227/neu.0000000000001988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 02/28/2022] [Indexed: 11/19/2022] Open
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Sankey EW, Grabowski MM, Srinivasan ES, Griffin AS, Howell EP, Otvos B, Tsvankin V, Barnett GH, Mohammadi AM, Fecci PE. Time to Steroid Independence After Laser Interstitial Thermal Therapy vs Medical Management for Treatment of Biopsy-Proven Radiation Necrosis Secondary to Stereotactic Radiosurgery for Brain Metastasis. Neurosurgery 2022; 90:684-690. [DOI: 10.1227/neu.0000000000001922] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 12/05/2021] [Indexed: 12/14/2022] Open
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12
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Luther E, Kaur G, Komotar RJ, Ivan ME. Commentary: An Update of Neuroanesthesia for Intraoperative Brain Mapping Craniotomy. Neurosurgery 2022; 90:e1-e2. [PMID: 33733271 DOI: 10.1093/neuros/nyab065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 01/14/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- Evan Luther
- Department of Neurological Surgery, Miller School of Medicine, University of Miami , Miami , Florida , USA
| | - Gurvinder Kaur
- Department of Neurological Surgery, Miller School of Medicine, University of Miami , Miami , Florida , USA
| | - Ricardo J Komotar
- Department of Neurological Surgery, Miller School of Medicine, University of Miami , Miami , Florida , USA.,Sylvester Comprehensive Cancer Center , Miami , Florida , USA
| | - Michael E Ivan
- Department of Neurological Surgery, Miller School of Medicine, University of Miami , Miami , Florida , USA.,Sylvester Comprehensive Cancer Center , Miami , Florida , USA
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Srinivasan ES, Grabowski MM, Nahed BV, Barnett GH, Fecci PE. Laser interstitial thermal therapy for brain metastases. Neurooncol Adv 2021; 3:v16-v25. [PMID: 34859229 PMCID: PMC8633752 DOI: 10.1093/noajnl/vdab128] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Laser interstitial thermal therapy (LITT) is a minimally invasive treatment for intracranial lesions entailing thermal ablation via a stereotactically placed laser probe. In metastatic disease, it has shown the most promise in the treatment of radiographically progressive lesions after initial stereotactic radiosurgery, whether due to recurrent metastatic disease or radiation necrosis. LITT has been demonstrated to provide clinical benefit in both cases, as discussed in the review below. With its minimal surgical footprint and short recovery period, LITT is further advantaged for patients who are otherwise high-risk surgical candidates or with lesions in difficult to access locations. Exploration of the current data on its use in metastatic disease will allow for a better understanding of the indications, benefits, and future directions of LITT for these patients.
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Affiliation(s)
| | - Matthew M Grabowski
- Department of Neurosurgery, Cleveland Clinic & Case Comprehensive Cancer Center, Cleveland, Ohio, USA
| | - Brian V Nahed
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Gene H Barnett
- Department of Neurosurgery, Cleveland Clinic & Case Comprehensive Cancer Center, Cleveland, Ohio, USA
| | - Peter E Fecci
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
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14
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Luther E, Lu VM, Morell AA, Elarjani T, Mansour S, Echeverry N, Gaztanaga W, King H, McCarthy D, Eichberg DG, Shah A, Burks J, Kaur G, Ivan ME, Komotar RJ. Supralesional Ablation Volumes Are Feasible in the Posterior Fossa and May Provide Enhanced Symptomatic Relief. Oper Neurosurg (Hagerstown) 2021; 21:418-425. [PMID: 34528092 DOI: 10.1093/ons/opab332] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 07/18/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Laser interstitial thermal therapy (LITT) for posterior fossa lesions remains rare as the small size of the infratentorial compartment, proximity to the brainstem, and thickness/angulation of the occipital bone creates barriers to procedural success. Furthermore, evaluation of the effect of ablation volume on outcomes is limited. OBJECTIVE To analyze our institutional experience with LITT in the posterior fossa stratifying perioperative and long-term outcomes by ablation volumes. METHODS Seventeen patients with posterior fossa lesions treated with LITT from 2013 to 2020 were identified. Local progression-free survival (PFS), overall survival, steroid dependence, and edema reduction were evaluated with Kaplan-Meier analysis grouped by ablation volume. Preoperative, postoperative, and last known Karnofsky Performance Status (KPS) were compared using a matched paired t test. RESULTS No differences in pathology, preoperative KPS, or preoperative lesion volume were found between patients with total (100%-200% increase in pre-LITT lesion volume) versus radical (>200% increase in pre-LITT lesion volume) ablations. Patients who underwent radical ablation had a higher postoperative KPS (93 vs 82, P = .02) and higher KPS (94 vs 87, P = .04) and greater reduction in perilesional edema at last follow-up (P = .01). Median follow-up was 80.8 wk. CONCLUSION Despite obvious anatomical challenges, our results demonstrate that radical ablations are both feasible and safe in the posterior fossa. Furthermore, radical ablations may lead to greater decreases in perilesional edema and improved functional status both immediately after surgery and at last follow-up. Thus, LITT should be considered for patients with otherwise unresectable or radioresistant posterior fossa lesions.
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Affiliation(s)
- Evan Luther
- University of Miami Miller School of Medicine, Department of Neurological Surgery, Miami, Florida, USA
| | - Victor M Lu
- University of Miami Miller School of Medicine, Department of Neurological Surgery, Miami, Florida, USA
| | - Alexis A Morell
- University of Miami Miller School of Medicine, Department of Neurological Surgery, Miami, Florida, USA
| | - Turki Elarjani
- University of Miami Miller School of Medicine, Department of Neurological Surgery, Miami, Florida, USA
| | - Samuel Mansour
- Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, Florida, USA
| | - Nikolas Echeverry
- Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, Florida, USA
| | - Wendy Gaztanaga
- University of Miami Miller School of Medicine, Department of Neurological Surgery, Miami, Florida, USA
| | - Hunter King
- Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - David McCarthy
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Daniel G Eichberg
- University of Miami Miller School of Medicine, Department of Neurological Surgery, Miami, Florida, USA
| | - Ashish Shah
- University of Miami Miller School of Medicine, Department of Neurological Surgery, Miami, Florida, USA
| | - Joshua Burks
- University of Miami Miller School of Medicine, Department of Neurological Surgery, Miami, Florida, USA
| | - Gurvinder Kaur
- University of Miami Miller School of Medicine, Department of Neurological Surgery, Miami, Florida, USA
| | - Michael E Ivan
- University of Miami Miller School of Medicine, Department of Neurological Surgery, Miami, Florida, USA.,Sylvester Comprehensive Cancer Center, University of Miami Health System, Miami, Florida, USA
| | - Ricardo J Komotar
- University of Miami Miller School of Medicine, Department of Neurological Surgery, Miami, Florida, USA.,Sylvester Comprehensive Cancer Center, University of Miami Health System, Miami, Florida, USA
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15
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Luther E, Kader M, Higgins D, Patel NV, Eichberg DG, Berry K, Wu EM, Morell A, Komotar R, Ivan M. Commentary: Resection of a Dumbbell-Shaped Facial Nerve Schwannoma With Preservation of Facial Nerve Function Through the Extended Middle Fossa Approach: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2021; 21:E532-E533. [PMID: 34560782 DOI: 10.1093/ons/opab358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 08/06/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Evan Luther
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Michael Kader
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Dominique Higgins
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Nitesh V Patel
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Daniel G Eichberg
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Katherine Berry
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Eva M Wu
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Alexis Morell
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ricardo Komotar
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.,Sylvester Comprehensive Cancer Center, Miami, Florida, USA
| | - Michael Ivan
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.,Sylvester Comprehensive Cancer Center, Miami, Florida, USA
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16
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Luther E, Kaur G, Komotar R, Ivan ME. Commentary: Resection of a Medulla Oblongata Hemangioblastoma: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2021; 21:E436-E437. [PMID: 34409995 DOI: 10.1093/ons/opab295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 07/06/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Evan Luther
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Gurvinder Kaur
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ricardo Komotar
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.,Sylvester Comprehensive Cancer Center, Miami, Florida, USA
| | - Michael E Ivan
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.,Sylvester Comprehensive Cancer Center, Miami, Florida, USA
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17
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Luther E, Kaur G, Komotar R, Ivan ME. Commentary: Concomitant Embolization and Microsurgical Resection of a Giant, Hypervascular Skull Base Meningioma: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2021; 21:E99-E100. [PMID: 34015826 DOI: 10.1093/ons/opab164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 03/22/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- Evan Luther
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Gurvinder Kaur
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ricardo Komotar
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.,Sylvester Comprehensive Cancer Center, Miami, Florida, USA
| | - Michael E Ivan
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.,Sylvester Comprehensive Cancer Center, Miami, Florida, USA
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18
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Luther E, Kaur G, Komotar R, Dinh C, Ivan ME. Commentary: Interposition Grafting of the Facial Nerve After Resection of a Large Facial Nerve Schwannoma: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2021; 21:E342-E343. [PMID: 34235543 DOI: 10.1093/ons/opab254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 06/02/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Evan Luther
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Gurvinder Kaur
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ricardo Komotar
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.,Sylvester Comprehensive Cancer Center, Miami, Florida, USA
| | - Christine Dinh
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Michael E Ivan
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.,Sylvester Comprehensive Cancer Center, Miami, Florida, USA
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19
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Chen C, Guo Y, Chen Y, Li Y, Chen J. The efficacy of laser interstitial thermal therapy for brain metastases with in-field recurrence following SRS: systemic review and meta-analysis. Int J Hyperthermia 2021; 38:273-281. [PMID: 33612043 DOI: 10.1080/02656736.2021.1889696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE To study the efficacy of LITT for BM patients experiencing in-field recurrence following SRS. METHODS A literature search was conducted to identify studies investigating local control (LC) rate and overall survival (OS) of LITT for BMs with IFR following SRS. RESULTS Analysis included 14 studies (470 patients with 542 lesions). The 6-month (LC-6) and 12-month (LC-12) local control rates were 78.5% (95% CI: 70.6-84.8%) and 69.0% (95% CI: 60.0-76.7%) separately. Pooled median OS was 17.15 months (95% CI: 13.27-24.8). The overall OS-6 and OS-12 rates were 76.0% (95% CI: 71.4-80.0%) and 63.4% (95% CI: 52.9-72.7%) separately. LITT provided more favorable local control efficacy in RN than BM recurrence (LC-6: 87.4% vs. 67.9%, p = 0.009; LC-12: 76.3% vs. 59.9%, p = 0.041). CONCLUSIONS LITT is an effective treatment for BM patients experiencing IFR following SRS. For different pathological entities, LITT showed more satisfactory local control efficacy on RN than BM recurrence.
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Affiliation(s)
- Chao Chen
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Yibin Guo
- Department of Health Statistics, Second Military Medical University, Shanghai, China
| | - Yi Chen
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Yanan Li
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Juxiang Chen
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China
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20
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Eichberg DG, Komotar RJ, Ivan ME. Commentary: Altered Motor Excitability in Patients With Diffuse Gliomas Involving Motor Eloquent Areas: The Impact of Tumor Grading. Neurosurgery 2021; 88:E39-E40. [PMID: 32888310 DOI: 10.1093/neuros/nyaa390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 07/02/2020] [Indexed: 02/07/2023] Open
Affiliation(s)
- Daniel G Eichberg
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Ricardo J Komotar
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida.,Sylvester Comprehensive Cancer Center, Miami, Florida
| | - Michael E Ivan
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida.,Sylvester Comprehensive Cancer Center, Miami, Florida
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21
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Eichberg DG, Komotar RJ, Ivan ME. Commentary: Laser Interstitial Thermal Therapy Case Series: Choosing the Correct Number of Fibers Depending on Lesion Size. Oper Neurosurg (Hagerstown) 2020; 20:E1-E2. [PMID: 32860064 DOI: 10.1093/ons/opaa274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 07/02/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- Daniel G Eichberg
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Ricardo J Komotar
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida.,Sylvester Comprehensive Cancer Center, Miami, Florida
| | - Michael E Ivan
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida.,Sylvester Comprehensive Cancer Center, Miami, Florida
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22
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Jamshidi AM, Eichberg DG, Komotar RJ, Ivan M. Safety Analysis of Bilateral Laser Interstitial Thermal Therapy for Treatment of Butterfly Glioma. World Neurosurg 2020; 144:e156-e163. [DOI: 10.1016/j.wneu.2020.08.053] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/05/2020] [Accepted: 08/06/2020] [Indexed: 11/28/2022]
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23
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Eichberg DG, Komotar RJ, Ivan ME. Commentary: Characterization of Magnetic Resonance Thermal Imaging Signal Artifact During Magnetic Resonance Guided Laser-Induced Thermal Therapy. Oper Neurosurg (Hagerstown) 2020; 19:E512-E513. [PMID: 32814960 DOI: 10.1093/ons/opaa255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 06/21/2020] [Indexed: 11/12/2022] Open
Affiliation(s)
- Daniel G Eichberg
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Ricardo J Komotar
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida.,Sylvester Comprehensive Cancer Center, Miami, Florida
| | - Michael E Ivan
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida.,Sylvester Comprehensive Cancer Center, Miami, Florida
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24
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Ashraf O, Arzumanov G, Luther E, McMahon JT, Malcolm JG, Mansour S, Lee IY, Willie JT, Komotar RJ, Danish SF. Magnetic resonance-guided laser interstitial thermal therapy for posterior fossa neoplasms. J Neurooncol 2020; 149:533-542. [PMID: 33057919 DOI: 10.1007/s11060-020-03645-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 10/08/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Magnetic resonance-guided laser interstitial thermal therapy (LITT) has been increasingly used to treat a number of intracranial pathologies, though its use in the posterior fossa has been limited to a few small series. We performed a multi-institutional review of targets in the posterior fossa, reporting the efficacy and safety profile associated with laser ablation in this region of the brain. METHODS A retrospective review of patients undergoing LITT in the posterior fossa was performed from August 2010 to March 2020. Patient demographic information was collected alongside the operative parameters and patient outcomes. Reported outcomes included local control of the lesion, postoperative complications, hospital length of stay, and steroid requirements. RESULTS 58 patients across four institutions underwent LITT in the posterior fossa for 60 tumors. The median pre-ablation tumor volume was 2.24 cm3. 48 patients (50 tumors) were available for follow-up. An 84% (42/50) overall local control rate was achieved at 9.5 months median follow up. There were two procedural complications, including insertional hemorrhage and laser misplacement and 12/58 (21%) patients developed new neurological deficits. There was one procedure related death. The median length of hospital stay was 1 day, with 20.7% of patients requiring discharge to a rehabilitation facility. CONCLUSIONS LITT is an effective approach for treating pathology in the posterior fossa. The average target size is smaller than what has been reported in the supratentorial space. Care must be taken to prevent injury to surrounding structures given the close proximity of critical structures in this region.
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Affiliation(s)
- Omar Ashraf
- Department of Neurosurgery, Rutgers Robert Wood Johnson Medical School, 10 Plum St. 5th Floor, New Brunswick, NJ, 08901, USA
| | - Grant Arzumanov
- Department of Neurosurgery, Rutgers Robert Wood Johnson Medical School, 10 Plum St. 5th Floor, New Brunswick, NJ, 08901, USA
| | - Evan Luther
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, 33101, USA
| | - J Tanner McMahon
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - James G Malcolm
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Samuel Mansour
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, 33431, USA
| | - Ian Y Lee
- Department of Neurosurgery, Henry Ford Hospital, Detroit, MI, 48202, USA
| | - Jon T Willie
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Ricardo J Komotar
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, 33101, USA
| | - Shabbar F Danish
- Department of Neurosurgery, Rutgers Robert Wood Johnson Medical School, 10 Plum St. 5th Floor, New Brunswick, NJ, 08901, USA.
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25
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Luther E, Mansour S, Echeverry N, McCarthy D, Eichberg DG, Shah A, Nada A, Berry K, Kader M, Ivan M, Komotar R. Laser Ablation for Cerebral Metastases. Neurosurg Clin N Am 2020; 31:537-547. [DOI: 10.1016/j.nec.2020.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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26
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Tan SK, Luther E, Eichberg D, Shah A, Khan K, Jamshidi A, Ivan M, Gultekin SH, Komotar R. Complete Regression of a Solitary Cholangiocarcinoma Brain Metastasis Following Laser Interstitial Thermal Therapy. World Neurosurg 2020; 144:94-98. [PMID: 32841795 DOI: 10.1016/j.wneu.2020.08.122] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 08/17/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND To our knowledge, we report the first case of a cholangiocarcinoma brain metastasis successfully treated with magnetic resonance imaging (MRI)-guided laser interstitial thermal therapy. CASE DESCRIPTION In 2017, a 71-year-old man was diagnosed with unresectable intrahepatic cholangiocarcinoma. In August 2018, a brain MRI scan was performed after a transient episode of altered mental status and revealed a subcentimeter enhancing lesion in the deep white matter of the right cerebellum. Due to lack of symptoms and the small size of the lesion, it was initially observed. However, a follow-up MRI scan at 2.5 months demonstrated increased lesion size with worsening perilesional edema. Given the rarity of cholangiocarcinoma brain metastases and the deep location, the patient underwent stereotactic needle biopsy to confirm the diagnosis followed by laser ablation as a primary treatment for the metastasis. The patient tolerated the surgery well with no complications, and the postoperative course was uneventful. At 16 months postablation, there has been no recurrence or disease progression. CONCLUSIONS Although prognosis for these tumors is poor, our result suggests that laser ablation can be an effective treatment for this rare entity and is a representative example of the expanding indications for laser interstitial thermal therapy.
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Affiliation(s)
- Sze Kiat Tan
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
| | - Evan Luther
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Daniel Eichberg
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ashish Shah
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Khadeja Khan
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Aria Jamshidi
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Michael Ivan
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Sakir Humayun Gultekin
- Department of Pathology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ricardo Komotar
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
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