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Salem U, Kumar VA, Madewell JE, Schomer DF, de Almeida Bastos DC, Zinn PO, Weinberg JS, Rao G, Prabhu SS, Colen RR. Neurosurgical applications of MRI guided laser interstitial thermal therapy (LITT). Cancer Imaging 2019; 19:65. [PMID: 31615562 PMCID: PMC6792239 DOI: 10.1186/s40644-019-0250-4] [Citation(s) in RCA: 96] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 08/30/2019] [Indexed: 02/02/2023] Open
Abstract
MRI-guided laser interstitial thermal therapy (LITT) is the selective ablation of a lesion or a tissue using heat emitted from a laser device. LITT is considered a less invasive technique compared to open surgery that provides a nonsurgical solution for patients who cannot tolerate surgery. Although laser ablation has been used to treat brain lesions for decades, recent advances in MRI have improved lesion targeting and enabled real-time accurate monitoring of the thermal ablation process. These advances have led to a plethora of research involving the technique, safety, and potential applications of LITT.LITT is a minimally invasive treatment modality that shows promising results and is associated with decreased morbidity. It has various applications, such as treatment of glioma, brain metastases, radiation necrosis, and epilepsy. It can provide a safer alternative treatment option for patients in whom the lesion is not accessible by surgery, who are not surgical candidates, or in whom other standard treatment options have failed. Our aim is to review the current literature on LITT and provide a descriptive review of the technique, imaging findings, and clinical applications for neurosurgery.
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Affiliation(s)
- Usama Salem
- Department of Radiology, The University of Texas Medical Branch at Galveston, Galveston, TX, 77555, USA.
| | - Vinodh A Kumar
- Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - John E Madewell
- Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Donald F Schomer
- Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | | | - Pascal O Zinn
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA, 15232, USA
| | - Jeffrey S Weinberg
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Ganesh Rao
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Sujit S Prabhu
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Rivka R Colen
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA, 15232, USA. .,Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, PA, 15232, USA.
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Jermakowicz WJ, Hentall ID, Jagid JR, Luca CC, Adcock J, Martinez-Arizala A, Widerström-Noga E. Deep Brain Stimulation Improves the Symptoms and Sensory Signs of Persistent Central Neuropathic Pain from Spinal Cord Injury: A Case Report. Front Hum Neurosci 2017; 11:177. [PMID: 28428749 PMCID: PMC5382156 DOI: 10.3389/fnhum.2017.00177] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 03/27/2017] [Indexed: 01/05/2023] Open
Abstract
Central neuropathic pain (CNP) is a significant problem after spinal cord injury (SCI). Pharmacological and non-pharmacological approaches may reduce the severity, but relief is rarely substantial. While deep brain stimulation (DBS) has been used to treat various chronic pain types, the technique has rarely been used to attenuate CNP after SCI. Here we present the case of a 54-year-old female with incomplete paraplegia who had severe CNP in the lower limbs and buttock areas since her injury 30 years prior. She was treated with bilateral DBS of the midbrain periaqueductal gray (PAG). The effects of this stimulation on CNP characteristics, severity and pain-related sensory function were evaluated using the International SCI Pain Basic Data Set (ISCIPBDS), Neuropathic Pain Symptom Inventory (NPSI), Multidimensional Pain Inventory and Quantitative Sensory Testing before and periodically after initiation of DBS. After starting DBS treatment, weekly CNP severity ratings rapidly decreased from severe to minimal, paralleled by a substantial reduction in size of the painful area, reduced pain impact and reversal of pain-related neurological abnormalities, i.e., dynamic-mechanical and cold allodynia. She discontinued pain medication on study week 24. The improvement has been consistent. The present study expands on previous findings by providing in-depth assessments of symptoms and signs associated with CNP. The results of this study suggest that activation of endogenous pain inhibitory systems linked to the PAG can eliminate CNP in some people with SCI. More research is needed to better-select appropriate candidates for this type of therapy. We discuss the implications of these findings for understanding the brainstem's control of chronic pain and for future progress in using analgesic DBS in the central gray.
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Affiliation(s)
- Walter J Jermakowicz
- The Miami Project to Cure Paralysis, Miller School of Medicine, University of MiamiMiami, FL, USA.,Department of Neurological Surgery, Miller School of Medicine, University of MiamiMiami, FL, USA
| | - Ian D Hentall
- The Miami Project to Cure Paralysis, Miller School of Medicine, University of MiamiMiami, FL, USA.,Department of Neurological Surgery, Miller School of Medicine, University of MiamiMiami, FL, USA.,Research Service, Bruce W. Carter Department of Veterans Affairs Medical CenterMiami, FL, USA
| | - Jonathan R Jagid
- The Miami Project to Cure Paralysis, Miller School of Medicine, University of MiamiMiami, FL, USA.,Research Service, Bruce W. Carter Department of Veterans Affairs Medical CenterMiami, FL, USA
| | - Corneliu C Luca
- Research Service, Bruce W. Carter Department of Veterans Affairs Medical CenterMiami, FL, USA.,Department of Neurology, Miller School of Medicine, University of MiamiMiami, FL, USA
| | - James Adcock
- The Miami Project to Cure Paralysis, Miller School of Medicine, University of MiamiMiami, FL, USA.,Research Service, Bruce W. Carter Department of Veterans Affairs Medical CenterMiami, FL, USA
| | - Alberto Martinez-Arizala
- The Miami Project to Cure Paralysis, Miller School of Medicine, University of MiamiMiami, FL, USA.,Department of Neurological Surgery, Miller School of Medicine, University of MiamiMiami, FL, USA.,Research Service, Bruce W. Carter Department of Veterans Affairs Medical CenterMiami, FL, USA.,Department of Neurology, Miller School of Medicine, University of MiamiMiami, FL, USA
| | - Eva Widerström-Noga
- The Miami Project to Cure Paralysis, Miller School of Medicine, University of MiamiMiami, FL, USA.,Department of Neurological Surgery, Miller School of Medicine, University of MiamiMiami, FL, USA.,Research Service, Bruce W. Carter Department of Veterans Affairs Medical CenterMiami, FL, USA
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