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Xu Z, Piao X, Wang M, Pichardo S, Cheng B. Microbubble-enhanced transcranial MR-guided focused ultrasound brain hyperthermia: heating mechanism investigation using finite element method. ULTRASONICS SONOCHEMISTRY 2024; 107:106889. [PMID: 38702233 PMCID: PMC11214346 DOI: 10.1016/j.ultsonch.2024.106889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/24/2024] [Accepted: 04/26/2024] [Indexed: 05/06/2024]
Abstract
Recently, our group developed a synergistic brain drug delivery method to achieve simultaneous transcranial hyperthermia and localized blood-brain barrier opening via MR-guided focused ultrasound (MRgFUS). In a rodent model, we demonstrated that the ultrasound power required for transcranial MRgFUS hyperthermia was significantly reduced by injecting microbubbles (MBs). However, the specific mechanisms underlying the power reduction caused by MBs remain unclear. The present study aims to elucidate the mechanisms of MB-enhanced transcranial MRgFUS hyperthermia through numerical studies using the finite element method. The microbubble acoustic emission (MAE) and the viscous dissipation (VD) were hypothesized to be the specific mechanisms. Acoustic wave propagation was used to model the FUS propagation in the brain tissue, and a bubble dynamics equation for describing the dynamics of MBs with small shell thickness was used to model the MB oscillation under FUS exposures. A modified bioheat transfer equation was used to model the temperature in the rodent brain with different heat sources. A theoretical model was used to estimate the bubble shell's surface tension, elasticity, and viscosity losses. The simulation reveals that MAE and VD caused a 40.5% and 52.3% additional temperature rise, respectively. Compared with FUS only, MBs caused a 64.0% temperature increase, which is consistent with our previous animal experiments. Our investigation showed that MAE and VD are the main mechanisms of MB-enhanced transcranial MRgFUS hyperthermia.
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Affiliation(s)
- Zhouyang Xu
- Translational Research in Ultrasound Theranostics Laboratory, School of Biomedical Engineering, ShanghaiTech University, Shanghai, China; State Key Laboratory of Advanced Medical Materials and Devices, ShanghaiTech University, Shanghai, China
| | - Xiangkun Piao
- Translational Research in Ultrasound Theranostics Laboratory, School of Biomedical Engineering, ShanghaiTech University, Shanghai, China; State Key Laboratory of Advanced Medical Materials and Devices, ShanghaiTech University, Shanghai, China
| | - Mingyu Wang
- Translational Research in Ultrasound Theranostics Laboratory, School of Biomedical Engineering, ShanghaiTech University, Shanghai, China; State Key Laboratory of Advanced Medical Materials and Devices, ShanghaiTech University, Shanghai, China
| | - Samuel Pichardo
- Department of Radiology, University of Calgary, Calgary, Canada; Department of Clinical Neurosciences, University of Calgary, Calgary, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - Bingbing Cheng
- Translational Research in Ultrasound Theranostics Laboratory, School of Biomedical Engineering, ShanghaiTech University, Shanghai, China; State Key Laboratory of Advanced Medical Materials and Devices, ShanghaiTech University, Shanghai, China.
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Zhang Z, Du Y, Shi X, Wang K, Qu Q, Liang Q, Ma X, He K, Chi C, Tang J, Liu B, Ji J, Wang J, Dong J, Hu Z, Tian J. NIR-II light in clinical oncology: opportunities and challenges. Nat Rev Clin Oncol 2024; 21:449-467. [PMID: 38693335 DOI: 10.1038/s41571-024-00892-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2024] [Indexed: 05/03/2024]
Abstract
Novel strategies utilizing light in the second near-infrared region (NIR-II; 900-1,880 nm wavelengths) offer the potential to visualize and treat solid tumours with enhanced precision. Over the past few decades, numerous techniques leveraging NIR-II light have been developed with the aim of precisely eliminating tumours while maximally preserving organ function. During cancer surgery, NIR-II optical imaging enables the visualization of clinically occult lesions and surrounding vital structures with increased sensitivity and resolution, thereby enhancing surgical quality and improving patient prognosis. Furthermore, the use of NIR-II light promises to improve cancer phototherapy by enabling the selective delivery of increased therapeutic energy to tissues at greater depths. Initial clinical studies of NIR-II-based imaging and phototherapy have indicated impressive potential to decrease cancer recurrence, reduce complications and prolong survival. Despite the encouraging results achieved, clinical translation of innovative NIR-II techniques remains challenging and inefficient; multidisciplinary cooperation is necessary to bridge the gap between preclinical research and clinical practice, and thus accelerate the translation of technical advances into clinical benefits. In this Review, we summarize the available clinical data on NIR-II-based imaging and phototherapy, demonstrating the feasibility and utility of integrating these technologies into the treatment of cancer. We also introduce emerging NIR-II-based approaches with substantial potential to further enhance patient outcomes, while also highlighting the challenges associated with imminent clinical studies of these modalities.
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Affiliation(s)
- Zeyu Zhang
- Key Laboratory of Big Data-Based Precision Medicine of Ministry of Industry and Information Technology, School of Engineering Medicine, Beihang University, Beijing, China
| | - Yang Du
- CAS Key Laboratory of Molecular Imaging, Beijing Key Laboratory of Molecular Imaging, Chinese Academy of Sciences, Beijing, China
| | - Xiaojing Shi
- CAS Key Laboratory of Molecular Imaging, Beijing Key Laboratory of Molecular Imaging, Chinese Academy of Sciences, Beijing, China
| | - Kun Wang
- CAS Key Laboratory of Molecular Imaging, Beijing Key Laboratory of Molecular Imaging, Chinese Academy of Sciences, Beijing, China
| | - Qiaojun Qu
- Department of Radiology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Qian Liang
- CAS Key Laboratory of Molecular Imaging, Beijing Key Laboratory of Molecular Imaging, Chinese Academy of Sciences, Beijing, China
| | - Xiaopeng Ma
- School of Control Science and Engineering, Shandong University, Jinan, China
| | - Kunshan He
- CAS Key Laboratory of Molecular Imaging, Beijing Key Laboratory of Molecular Imaging, Chinese Academy of Sciences, Beijing, China
| | - Chongwei Chi
- CAS Key Laboratory of Molecular Imaging, Beijing Key Laboratory of Molecular Imaging, Chinese Academy of Sciences, Beijing, China
| | - Jianqiang Tang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bo Liu
- Department of General Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jiafu Ji
- Department of Gastrointestinal Surgery, Peking University Cancer Hospital and Institute, Beijing, China.
| | - Jun Wang
- Thoracic Oncology Institute/Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China.
| | - Jiahong Dong
- Hepatopancreatobiliary Center, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.
| | - Zhenhua Hu
- CAS Key Laboratory of Molecular Imaging, Beijing Key Laboratory of Molecular Imaging, Chinese Academy of Sciences, Beijing, China.
| | - Jie Tian
- Key Laboratory of Big Data-Based Precision Medicine of Ministry of Industry and Information Technology, School of Engineering Medicine, Beihang University, Beijing, China.
- CAS Key Laboratory of Molecular Imaging, Beijing Key Laboratory of Molecular Imaging, Chinese Academy of Sciences, Beijing, China.
- Engineering Research Center of Molecular and Neuro Imaging of Ministry of Education, School of Life Science and Technology, Xidian University, Xi'an, China.
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Hamade YJ, Dharnipragada R, Chen CC. The ClearPoint Array Frame: An MRI Compatible System that Supports Non-craniotomy, Multi-trajectory (NCMT) Stereotactic Procedures. World Neurosurg 2024; 184:e754-e764. [PMID: 38350598 DOI: 10.1016/j.wneu.2024.02.029] [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: 11/22/2023] [Revised: 02/04/2024] [Accepted: 02/05/2024] [Indexed: 02/15/2024]
Abstract
BACKGROUND With continued evolution in stereotactic techniques and an expanding armamentarium of surgical therapeutic options, non-craniotomy stereotactic procedures in neuro-oncology are becoming increasingly complex, often requiring multi-trajectory approaches. Here we demonstrate that the ClearPoint SmartFrame Array (Solana Beach, California, USA), a second-generation magnetic resonance imaging-compatible stereotactic frame, supports such non-craniotomy, multi-trajectory (NCMT) stereotactic procedures. METHODS We previously published case reports demonstrating the feasibility of NCMT through the ClearPoint SmartFrame Array. Here we prospectively followed the next 10 consecutive patients who underwent such multi-trajectory procedures to further establish procedural safety and clinical utility. RESULTS Ten patients underwent complex, multi-trajectory stereotactic procedures, including combinations of needle biopsy ± cyst drainage and laser interstitial thermal therapy targeting geographically distinct regions of neoplastic lesions under the same anesthetic event. The median maximal radial error of stereotaxis was 1.0 mm. In all cases, definitive diagnosis was achieved, and >90% of the intended targets were ablated. The average stereotaxis time for the multi-trajectory procedure was 119 ± 22.2 minutes, comparing favorably to our previously published results of single-trajectory procedures (80 ± 9.59 minutes, P = 0.125). There were no procedural complications. Post-procedure, the neurologic condition of 1 patient improved, while the remaining 9 patients remained stable. All patients were discharged home, with a median hospital stay of 1 day (range: 1-12 days). With a median follow-up of 376 days (range: 155-1438 days), there were no 30-day readmissions or wound complications. CONCLUSIONS Geographically distinct regions of brain cancer can be safely and accurately accessed through the ClearPoint Array frame in NCMT stereotactic procedures.
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Affiliation(s)
- Youssef J Hamade
- Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Rajiv Dharnipragada
- University of Minnesota Medical School, University of Minnesota Twin-Cities, Minneapolis, Minnesota, USA
| | - Clark C Chen
- Department of Neurosurgery, Warren Alpert School of Medicine, Rhode Island Hospital, Brown University, Providence, Rhode Island, USA.
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Singh S, Bianchi L, Korganbayev S, Namakshenas P, Melnik R, Saccomandi P. Non-Fourier Bioheat Transfer Analysis in Brain Tissue During Interstitial Laser Ablation: Analysis of Multiple Influential Factors. Ann Biomed Eng 2024; 52:967-981. [PMID: 38236341 PMCID: PMC11252202 DOI: 10.1007/s10439-023-03433-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 12/22/2023] [Indexed: 01/19/2024]
Abstract
This work presents the dual-phase lag-based non-Fourier bioheat transfer model of brain tissue subjected to interstitial laser ablation. The finite element method has been utilized to predict the brain tissue's temperature distributions and ablation volumes. A sensitivity analysis has been conducted to quantify the effect of variations in the input laser power, treatment time, laser fiber diameter, laser wavelength, and non-Fourier phase lags. Notably, in this work, the temperature-dependent thermal properties of brain tissue have been considered. The developed model has been validated by comparing the temperature obtained from the numerical and ex vivo brain tissue during interstitial laser ablation. The ex vivo brain model has been further extended to in vivo settings by incorporating the blood perfusion effects. The results of the systematic analysis highlight the importance of considering temperature-dependent thermal properties of the brain tissue, non-Fourier behavior, and microvascular perfusion effects in the computational models for accurate predictions of the treatment outcomes during interstitial laser ablation, thereby minimizing the damage to surrounding healthy tissue. The developed model and parametric analysis reported in this study would assist in a more accurate and precise prediction of the temperature distribution, thus allowing to optimize the thermal dosage during laser therapy in the brain.
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Affiliation(s)
- Sundeep Singh
- Faculty of Sustainable Design Engineering, University of Prince Edward Island, Charlottetown, PE, C1A 4P3, Canada
| | - Leonardo Bianchi
- Department of Mechanical Engineering, Politecnico di Milano, 20156, Milan, Italy
| | - Sanzhar Korganbayev
- Department of Mechanical Engineering, Politecnico di Milano, 20156, Milan, Italy
| | - Pouya Namakshenas
- Department of Mechanical Engineering, Politecnico di Milano, 20156, Milan, Italy
| | - Roderick Melnik
- MS2Discovery Interdisciplinary Research Institute, Wilfrid Laurier University, Waterloo, ON, Canada
| | - Paola Saccomandi
- Department of Mechanical Engineering, Politecnico di Milano, 20156, Milan, Italy.
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Jubran JH, Scherschinski L, Dholaria N, Shaftel KA, Farhadi DS, Oladokun FC, Hendricks BK, Smith KA. Magnetic Resonance-Guided Laser Interstitial Thermal Therapy for Recurrent Glioblastoma and Radiation Necrosis: A Single-Surgeon Case Series. World Neurosurg 2024; 182:e453-e462. [PMID: 38036173 DOI: 10.1016/j.wneu.2023.11.120] [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: 11/16/2023] [Accepted: 11/24/2023] [Indexed: 12/02/2023]
Abstract
OBJECTIVE To evaluate long-term clinical outcomes among patients treated with laser interstitial thermal therapy (LITT) for predicted recurrent glioblastoma (rGBM). METHODS Patients with rGBM treated by LITT by a single surgeon (2013-2020) were evaluated for progression-free survival (PFS), overall survival (OS), and OS after LITT. RESULTS Forty-nine patients (33 men, 16 women; mean [SD] age at diagnosis, 58.7 [12.5] years) were evaluated. Among patients with genetic data, 6 of 34 (18%) had IDH-1 R132 mutations, and 7 of 21 (33%) had MGMT methylation. Patients underwent LITT at a mean (SD) of 23.8 (23.8) months after original diagnosis. Twenty of 49 (40%) had previously undergone stereotactic radiosurgery, 37 (75%) had undergone intensity-modulated radiation therapy, and 49 (100%) had undergone chemotherapy. Patients had undergone a mean of 1.2 (0.7) previous resections before LITT. Mean preoperative enhancing and T2 FLAIR volumes were 13.1 (12.8) cm3 and 35.0 (32.8) cm3, respectively. Intraoperative biopsies confirmed rGBM in 31 patients (63%) and radiation necrosis in 18 patients (37%). Six perioperative complications occurred: 3 (6%) cases of worsening aphasia, 1 (2%) seizure, 1 (2%) epidural hematoma, and 1 (2%) intraparenchymal hemorrhage. For the rGBM group, median PFS was 2.0 (IQR, 4.0) months, median OS was 20.0 (IQR, 29.5) months, and median OS after LITT was 6.0 (IQR, 10.5) months. For the radiation necrosis group, median PFS was 4.0 (IQR, 4.5) months, median OS was 37.0 (IQR, 58.0) months, and median OS after LITT was 8.0 (IQR, 23.5) months. CONCLUSIONS In a diverse rGBM cohort, LITT was associated with a short duration of posttreatment PFS.
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Affiliation(s)
- Jubran H Jubran
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Lea Scherschinski
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Nikhil Dholaria
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Kelly A Shaftel
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Dara S Farhadi
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Femi C Oladokun
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Benjamin K Hendricks
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Kris A Smith
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
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He Z, Dai J, Ho JDL, Tong HS, Wang X, Fang G, Liang L, Cheung CL, Guo Z, Chang HC, Iordachita I, Taylor RH, Poon WS, Chan DTM, Kwok KW. Interactive Multi-Stage Robotic Positioner for Intra-Operative MRI-Guided Stereotactic Neurosurgery. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024; 11:e2305495. [PMID: 38072667 PMCID: PMC10870025 DOI: 10.1002/advs.202305495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/30/2023] [Indexed: 02/17/2024]
Abstract
Magnetic resonance imaging (MRI) demonstrates clear advantages over other imaging modalities in neurosurgery with its ability to delineate critical neurovascular structures and cancerous tissue in high-resolution 3D anatomical roadmaps. However, its application has been limited to interventions performed based on static pre/post-operative imaging, where errors accrue from stereotactic frame setup, image registration, and brain shift. To leverage the powerful intra-operative functions of MRI, e.g., instrument tracking, monitoring of physiological changes and tissue temperature in MRI-guided bilateral stereotactic neurosurgery, a multi-stage robotic positioner is proposed. The system positions cannula/needle instruments using a lightweight (203 g) and compact (Ø97 × 81 mm) skull-mounted structure that fits within most standard imaging head coils. With optimized design in soft robotics, the system operates in two stages: i) manual coarse adjustment performed interactively by the surgeon (workspace of ±30°), ii) automatic fine adjustment with precise (<0.2° orientation error), responsive (1.4 Hz bandwidth), and high-resolution (0.058°) soft robotic positioning. Orientation locking provides sufficient transmission stiffness (4.07 N/mm) for instrument advancement. The system's clinical workflow and accuracy is validated with lab-based (<0.8 mm) and MRI-based testing on skull phantoms (<1.7 mm) and a cadaver subject (<2.2 mm). Custom-made wireless omni-directional tracking markers facilitated robot registration under MRI.
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Affiliation(s)
- Zhuoliang He
- Department of Mechanical Engineering, The University of Hong Kong, Hong Kong, 999077, China
| | - Jing Dai
- Department of Mechanical Engineering, The University of Hong Kong, Hong Kong, 999077, China
| | - Justin Di-Lang Ho
- Department of Mechanical Engineering, The University of Hong Kong, Hong Kong, 999077, China
| | - Hon-Sing Tong
- Department of Mechanical Engineering, The University of Hong Kong, Hong Kong, 999077, China
| | - Xiaomei Wang
- Department of Mechanical Engineering, The University of Hong Kong, Hong Kong, 999077, China
- Multi-Scale Medical Robotics Center, Hong Kong, 999077, China
| | - Ge Fang
- Department of Mechanical Engineering, The University of Hong Kong, Hong Kong, 999077, China
| | - Liyuan Liang
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong, 999077, China
- Multi-Scale Medical Robotics Center, Hong Kong, 999077, China
| | - Chim-Lee Cheung
- Department of Mechanical Engineering, The University of Hong Kong, Hong Kong, 999077, China
| | - Ziyan Guo
- Department of Medical Physics and Biomedical Engineering, University College London, London, WC1E 6BT, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, WC1E 6BT, UK
| | - Hing-Chiu Chang
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong, 999077, China
- Multi-Scale Medical Robotics Center, Hong Kong, 999077, China
| | - Iulian Iordachita
- Department of Mechanical Engineering and Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Russell H Taylor
- Department of Computer Science and Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Wai-Sang Poon
- Division of Neurosurgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, 999077, China
- Neuromedicine Center, Shenzhen Hospital, The University of Hong Kong, Shenzhen, 518053, China
| | - Danny Tat-Ming Chan
- Division of Neurosurgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, 999077, China
- Multi-Scale Medical Robotics Center, Hong Kong, 999077, China
| | - Ka-Wai Kwok
- Department of Mechanical Engineering, The University of Hong Kong, Hong Kong, 999077, China
- Multi-Scale Medical Robotics Center, Hong Kong, 999077, China
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Fan Y, Xu L, Liu S, Li J, Xia J, Qin X, Li Y, Gao T, Tang X. The State-of-the-Art and Perspectives of Laser Ablation for Tumor Treatment. CYBORG AND BIONIC SYSTEMS 2024; 5:0062. [PMID: 38188984 PMCID: PMC10769065 DOI: 10.34133/cbsystems.0062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/21/2023] [Indexed: 01/09/2024] Open
Abstract
Tumors significantly impact individuals' physical well-being and quality of life. With the ongoing advancements in optical technology, information technology, robotic technology, etc., laser technology is being increasingly utilized in the field of tumor treatment, and laser ablation (LA) of tumors remains a prominent area of research interest. This paper presents an overview of the recent progress in tumor LA therapy, with a focus on the mechanisms and biological effects of LA, commonly used ablation lasers, image-guided LA, and robotic-assisted LA. Further insights and future prospects are discussed in relation to these aspects, and the paper proposed potential future directions for the development of tumor LA techniques.
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Affiliation(s)
- Yingwei Fan
- School of Medical Technology, Beijing Institute of Technology, Beijing 100081, China
| | - Liancheng Xu
- School of Medical Technology, Beijing Institute of Technology, Beijing 100081, China
| | - Shuai Liu
- School of Medical Technology, Beijing Institute of Technology, Beijing 100081, China
| | - Jinhua Li
- School of Medical Technology, Beijing Institute of Technology, Beijing 100081, China
| | - Jialu Xia
- School of Materials Science and Engineering, Hefei University of Technology, Hefei 230009, China
| | - Xingping Qin
- John B. Little Center for Radiation Sciences, Harvard TH Chan School of Public Health, Boston, MA 02115, USA
| | - Yafeng Li
- China Electronics Harvest Technology Co. Ltd., China
| | - Tianxin Gao
- School of Medical Technology, Beijing Institute of Technology, Beijing 100081, China
| | - Xiaoying Tang
- School of Medical Technology, Beijing Institute of Technology, Beijing 100081, China
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Mellor NG, Chung SA, Graham ES, Day BW, Unsworth CP. Eliciting calcium transients with UV nanosecond laser stimulation in adult patient-derived glioblastoma brain cancer cells in vitro. J Neural Eng 2023; 20:066026. [PMID: 37988746 DOI: 10.1088/1741-2552/ad0e7d] [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: 10/03/2022] [Accepted: 11/21/2023] [Indexed: 11/23/2023]
Abstract
Objective.Glioblastoma (GBM) is the most common and lethal type of high-grade adult brain cancer. The World Health Organization have classed GBM as an incurable disease because standard treatments have yielded little improvement with life-expectancy being 6-15 months after diagnosis. Different approaches are now crucial to discover new knowledge about GBM communication/function in order to establish alternative therapies for such an aggressive adult brain cancer. Calcium (Ca2+) is a fundamental cell molecular messenger employed in GBM being involved in a wide dynamic range of cellular processes. Understanding how the movement of Ca2+behaves and modulates activity in GBM at the single-cell level is relatively unexplored but holds the potential to yield opportunities for new therapeutic strategies and approaches for cancer treatment.Approach.In this article we establish a spatially and temporally precise method for stimulating Ca2+transients in three patient-derived GBM cell-lines (FPW1, RN1, and RKI1) such that Ca2+communication can be studied from single-cell to larger network scales. We demonstrate that this is possible by administering a single optimized ultra-violet (UV) nanosecond laser pulse to trigger GBM Ca2+transients.Main results.We determine that 1.58µJµm-2is the optimal UV nanosecond laser pulse energy density necessary to elicit a single Ca2+transient in the GBM cell-lines whilst maintaining viability, functionality, the ability to be stimulated many times in an experiment, and to trigger further Ca2+communication in a larger network of GBM cells.Significance.Using adult patient-derived mesenchymal GBM brain cancer cell-lines, the most aggressive form of GBM cancer, this work is the first of its kind as it provides a new effective modality of which to stimulate GBM cells at the single-cell level in an accurate, repeatable, and reliable manner; and is a first step toward Ca2+communication in GBM brain cancer cells and their networks being more effectively studied.
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Affiliation(s)
- Nicholas G Mellor
- Department of Engineering Science, The University of Auckland, Auckland, New Zealand
| | - Sylvia A Chung
- Adult Cancer Program, Lowy Cancer Research Centre, The University of New South Wales, Sydney, Australia
| | - E Scott Graham
- Department of Molecular Medicine and Pathology & The Centre for Brain Research, The University of Auckland, Auckland, New Zealand
| | - Bryan W Day
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Charles P Unsworth
- Department of Engineering Science, The University of Auckland, Auckland, New Zealand
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Paolucci I, Bulatović M, Weber S, Tinguely P. Thermal ablation with configurable shapes: a comprehensive, automated model for bespoke tumor treatment. Eur Radiol Exp 2023; 7:67. [PMID: 37932631 PMCID: PMC10628015 DOI: 10.1186/s41747-023-00381-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 08/29/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND Malignant tumors routinely present with irregular shapes and complex configurations. The lack of customization to individual tumor shapes and standardization of procedures limits the success and application of thermal ablation. METHODS We introduced an automated treatment model consisting of (i) trajectory and ablation profile planning, (ii) ablation probe insertion, (iii) dynamic energy delivery (including robotically driven control of the energy source power and location over time, according to a treatment plan bespoke to the tumor shape), and (iv) quantitative ablation margin verification. We used a microwave ablation system and a liver phantom (acrylamide polymer with a thermochromic ink) to mimic coagulation and measure the ablation volume. We estimated the ablation width as a function of power and velocity following a probabilistic model. Four representative shapes of liver tumors < 5 cm were selected from two publicly available databases. The ablated specimens were cut along the ablation probe axis and photographed. The shape of the ablated volume was extracted using a color-based segmentation method. RESULTS The uncertainty (standard deviation) of the ablation width increased with increasing power by ± 0.03 mm (95% credible interval [0.02, 0.043]) per watt increase in power and by ± 0.85 mm (95% credible interval [0, 2.5]) per mm/s increase in velocity. Continuous ablation along a straight-line trajectory resulted in elongated rotationally symmetric ablation shapes. Simultaneous regulation of the power and/or translation velocity allowed to modulate the ablation width at specific locations. CONCLUSIONS This study offers the proof-of-principle of the dynamic energy delivery system using ablation shapes from clinical cases of malignant liver tumors. RELEVANCE STATEMENT The proposed automated treatment model could favor the customization and standardization of thermal ablation for complex tumor shapes. KEY POINTS • Current thermal ablation systems are limited to ellipsoidal or spherical shapes. • Dynamic energy delivery produces elongated rotationally symmetric ablation shapes with varying widths. • For complex tumor shapes, multiple customized ablation shapes could be combined.
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Affiliation(s)
- Iwan Paolucci
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland.
| | - Milica Bulatović
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Stefan Weber
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Pascale Tinguely
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
- Department of Visceral Surgery and Medicine, Inselspital, University Hospital Bern, Bern, Switzerland
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Lad Y, Jangam A, Carlton H, Abu-Ayyad M, Hadjipanayis C, Ivkov R, Zacharia BE, Attaluri A. Development of a Treatment Planning Framework for Laser Interstitial Thermal Therapy (LITT). Cancers (Basel) 2023; 15:4554. [PMID: 37760524 PMCID: PMC10526178 DOI: 10.3390/cancers15184554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/29/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023] Open
Abstract
PURPOSE Develop a treatment planning framework for neurosurgeons treating high-grade gliomas with LITT to minimize the learning curve and improve tumor thermal dose coverage. METHODS Deidentified patient images were segmented using the image segmentation software Materialize MIMICS©. Segmented images were imported into the commercial finite element analysis (FEA) software COMSOL Multiphysics© to perform bioheat transfer simulations. The laser probe was modeled as a cylindrical object with radius 0.7 mm and length 100 mm, with a constant beam diameter. A modeled laser probe was placed in the tumor in accordance with patient specific patient magnetic resonance temperature imaging (MRTi) data. The laser energy was modeled as a deposited beam heat source in the FEA software. Penne's bioheat equation was used to model heat transfer in brain tissue. The cerebrospinal fluid (CSF) was modeled as a solid with convectively enhanced conductivity to capture heat sink effects. In this study, thermal damage-dependent blood perfusion was assessed. Pulsed laser heating was modeled based on patient treatment logs. The stationary heat source and pullback heat source techniques were modeled to compare the calculated tissue damage. The developed bioheat transfer model was compared to MRTi data obtained from a laser log during LITT procedures. The application builder module in COMSOL Multiphysics© was utilized to create a Graphical User Interface (GUI) for the treatment planning framework. RESULTS Simulations predicted increased thermal damage (10-15%) in the tumor for the pullback heat source approach compared with the stationary heat source. The model-predicted temperature profiles followed trends similar to those of the MRTi data. Simulations predicted partial tissue ablation in tumors proximal to the CSF ventricle. CONCLUSION A mobile platform-based GUI for bioheat transfer simulation was developed to aid neurosurgeons in conveniently varying the simulation parameters according to a patient-specific treatment plan. The convective effects of the CSF should be modeled with heat sink effects for accurate LITT treatment planning.
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Affiliation(s)
- Yash Lad
- Department of Mechanical Engineering, School of Science, Engineering, and Technology, The Pennsylvania State University Harrisburg, Harrisburg, PA 17057, USA
| | - Avesh Jangam
- Department of Mechanical Engineering, School of Science, Engineering, and Technology, The Pennsylvania State University Harrisburg, Harrisburg, PA 17057, USA
| | - Hayden Carlton
- Department of Radiation Oncology and Molecular Radiation Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA
| | - Ma’Moun Abu-Ayyad
- Department of Mechanical Engineering, School of Science, Engineering, and Technology, The Pennsylvania State University Harrisburg, Harrisburg, PA 17057, USA
| | - Constantinos Hadjipanayis
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Robert Ivkov
- Department of Radiation Oncology and Molecular Radiation Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
- Department of Mechanical Engineering, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
- Department of Materials Science and Engineering, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Brad E. Zacharia
- Department of Neurosurgery, Pennsylvania State Health, Hershey, PA 17033, USA
| | - Anilchandra Attaluri
- Department of Mechanical Engineering, School of Science, Engineering, and Technology, The Pennsylvania State University Harrisburg, Harrisburg, PA 17057, USA
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Srinivasan ES, Liu Y, Odion RA, Chongsathidkiet P, Wachsmuth LP, Haskell-Mendoza AP, Edwards RM, Canning AJ, Willoughby G, Hinton J, Norton SJ, Lascola CD, Maccarini PF, Mariani CL, Vo-Dinh T, Fecci PE. Gold Nanostars Obviate Limitations to Laser Interstitial Thermal Therapy (LITT) for the Treatment of Intracranial Tumors. Clin Cancer Res 2023; 29:3214-3224. [PMID: 37327318 PMCID: PMC10425731 DOI: 10.1158/1078-0432.ccr-22-1871] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 03/27/2023] [Accepted: 06/14/2023] [Indexed: 06/18/2023]
Abstract
PURPOSE Laser interstitial thermal therapy (LITT) is an effective minimally invasive treatment option for intracranial tumors. Our group produced plasmonics-active gold nanostars (GNS) designed to preferentially accumulate within intracranial tumors and amplify the ablative capacity of LITT. EXPERIMENTAL DESIGN The impact of GNS on LITT coverage capacity was tested in ex vivo models using clinical LITT equipment and agarose gel-based phantoms of control and GNS-infused central "tumors." In vivo accumulation of GNS and amplification of ablation were tested in murine intracranial and extracranial tumor models followed by intravenous GNS injection, PET/CT, two-photon photoluminescence, inductively coupled plasma mass spectrometry (ICP-MS), histopathology, and laser ablation. RESULTS Monte Carlo simulations demonstrated the potential of GNS to accelerate and specify thermal distributions. In ex vivo cuboid tumor phantoms, the GNS-infused phantom heated 5.5× faster than the control. In a split-cylinder tumor phantom, the GNS-infused border heated 2× faster and the surrounding area was exposed to 30% lower temperatures, with margin conformation observed in a model of irregular GNS distribution. In vivo, GNS preferentially accumulated within intracranial tumors on PET/CT, two-photon photoluminescence, and ICP-MS at 24 and 72 hours and significantly expedited and increased the maximal temperature achieved in laser ablation compared with control. CONCLUSIONS Our results provide evidence for use of GNS to improve the efficiency and potentially safety of LITT. The in vivo data support selective accumulation within intracranial tumors and amplification of laser ablation, and the GNS-infused phantom experiments demonstrate increased rates of heating, heat contouring to tumor borders, and decreased heating of surrounding regions representing normal structures.
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Affiliation(s)
- Ethan S. Srinivasan
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina
| | - Yang Liu
- Department of Biomedical Engineering, Duke University, Durham, North Carolina
- Department of Chemistry, Duke University, Durham, North Carolina
- Fitzpatrick Institute of Photonics, Duke University, Durham, North Carolina
| | - Ren A. Odion
- Department of Biomedical Engineering, Duke University, Durham, North Carolina
- Fitzpatrick Institute of Photonics, Duke University, Durham, North Carolina
| | - Pakawat Chongsathidkiet
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina
- Department of Pathology, Duke University Medical Center, Durham, North Carolina
| | - Lucas P. Wachsmuth
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina
| | | | - Ryan M. Edwards
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina
| | - Aidan J. Canning
- Department of Biomedical Engineering, Duke University, Durham, North Carolina
- Fitzpatrick Institute of Photonics, Duke University, Durham, North Carolina
| | - Gavin Willoughby
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina
- Department of Pathology, Duke University Medical Center, Durham, North Carolina
| | - Joseph Hinton
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina
- Department of Pathology, Duke University Medical Center, Durham, North Carolina
| | - Stephen J. Norton
- Department of Biomedical Engineering, Duke University, Durham, North Carolina
- Fitzpatrick Institute of Photonics, Duke University, Durham, North Carolina
| | - Christopher D. Lascola
- Department of Radiology, Duke University Medical Center, Durham, North Carolina
- Department of Neurobiology, Duke University Medical Center, Durham, North Carolina
| | - Paolo F. Maccarini
- Department of Biomedical Engineering, Duke University, Durham, North Carolina
- Fitzpatrick Institute of Photonics, Duke University, Durham, North Carolina
| | - Christopher L. Mariani
- Department of Clinical Sciences, NC State College of Veterinary Medicine, Raleigh, North Carolina
| | - Tuan Vo-Dinh
- Department of Biomedical Engineering, Duke University, Durham, North Carolina
- Department of Chemistry, Duke University, Durham, North Carolina
- Fitzpatrick Institute of Photonics, Duke University, Durham, North Carolina
| | - Peter E. Fecci
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina
- Department of Pathology, Duke University Medical Center, Durham, North Carolina
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12
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Campelo SN, Lorenzo MF, Partridge B, Alinezhadbalalami N, Kani Y, Garcia J, Saunier S, Thomas SC, Hinckley J, Verbridge SS, Davalos RV, Rossmeisl JH. High-frequency irreversible electroporation improves survival and immune cell infiltration in rodents with malignant gliomas. Front Oncol 2023; 13:1171278. [PMID: 37213298 PMCID: PMC10196182 DOI: 10.3389/fonc.2023.1171278] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 04/24/2023] [Indexed: 05/23/2023] Open
Abstract
Background Irreversible electroporation (IRE) has been previously investigated in preclinical trials as a treatment for intracranial malignancies. Here, we investigate next generation high-frequency irreversible electroporation (H-FIRE), as both a monotherapy and a combinatorial therapy, for the treatment of malignant gliomas. Methods Hydrogel tissue scaffolds and numerical modeling were used to inform in-vivo H-FIRE pulsing parameters for our orthotopic tumor-bearing glioma model. Fischer rats were separated into five treatment cohorts including high-dose H-FIRE (1750V/cm), low-dose H-FIRE (600V/cm), combinatorial high-dose H-FIRE + liposomal doxorubicin, low-dose H-FIRE + liposomal doxorubicin, and standalone liposomal doxorubicin groups. Cohorts were compared against a standalone tumor-bearing sham group which received no therapeutic intervention. To further enhance the translational value of our work, we characterize the local and systemic immune responses to intracranial H-FIRE at the study timepoint. Results The median survival for each cohort are as follows: 31 days (high-dose H-FIRE), 38 days (low-dose H-FIRE), 37.5 days (high-dose H-FIRE + liposomal doxorubicin), 27 days (low-dose H-FIRE + liposomal doxorubicin), 20 days (liposomal doxorubicin), and 26 days (sham). A statistically greater overall survival fraction was noted in the high-dose H-FIRE + liposomal doxorubicin (50%, p = 0.044), high-dose H-FIRE (28.6%, p = 0.034), and the low-dose H-FIRE (20%, p = 0.0214) compared to the sham control (0%). Compared to sham controls, brain sections of rats treated with H-FIRE demonstrated significant increases in IHC scores for CD3+ T-cells (p = 0.0014), CD79a+ B-cells (p = 0.01), IBA-1+ dendritic cells/microglia (p = 0.04), CD8+ cytotoxic T-cells (p = 0.0004), and CD86+ M1 macrophages (p = 0.01). Conclusions H-FIRE may be used as both a monotherapy and a combinatorial therapy to improve survival in the treatment of malignant gliomas while also promoting the presence of infiltrative immune cells.
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Affiliation(s)
- Sabrina N. Campelo
- Bioelectromechanical Systems Laboratory, Virginia Tech, Blacksburg, VA, United States
- School of Biomedical Engineering and Sciences, Virginia Tech-Wake Forest University, Blacksburg, VA, United States
| | - Melvin F. Lorenzo
- Bioelectromechanical Systems Laboratory, Virginia Tech, Blacksburg, VA, United States
- School of Biomedical Engineering and Sciences, Virginia Tech-Wake Forest University, Blacksburg, VA, United States
| | - Brittanie Partridge
- Department of Small Animal Clinical Sciences, Virginia Tech, Blacksburg, VA, United States
| | - Nastaran Alinezhadbalalami
- Bioelectromechanical Systems Laboratory, Virginia Tech, Blacksburg, VA, United States
- School of Biomedical Engineering and Sciences, Virginia Tech-Wake Forest University, Blacksburg, VA, United States
| | - Yukitaka Kani
- Department of Small Animal Clinical Sciences, Virginia Tech, Blacksburg, VA, United States
| | - Josefa Garcia
- Department of Small Animal Clinical Sciences, Virginia Tech, Blacksburg, VA, United States
| | - Sofie Saunier
- Bioelectromechanical Systems Laboratory, Virginia Tech, Blacksburg, VA, United States
- School of Biomedical Engineering and Sciences, Virginia Tech-Wake Forest University, Blacksburg, VA, United States
| | - Sean C. Thomas
- School of Biomedical Engineering and Sciences, Virginia Tech-Wake Forest University, Blacksburg, VA, United States
| | - Jonathan Hinckley
- Department of Small Animal Clinical Sciences, Virginia Tech, Blacksburg, VA, United States
| | - Scott S. Verbridge
- School of Biomedical Engineering and Sciences, Virginia Tech-Wake Forest University, Blacksburg, VA, United States
| | - Rafael V. Davalos
- Bioelectromechanical Systems Laboratory, Virginia Tech, Blacksburg, VA, United States
- School of Biomedical Engineering and Sciences, Virginia Tech-Wake Forest University, Blacksburg, VA, United States
| | - John H. Rossmeisl
- Department of Small Animal Clinical Sciences, Virginia Tech, Blacksburg, VA, United States
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13
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Real-time automatic temperature regulation during in vivo MRI-guided laser-induced thermotherapy (MR-LITT). Sci Rep 2023; 13:3279. [PMID: 36841878 PMCID: PMC9968334 DOI: 10.1038/s41598-023-29818-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 02/10/2023] [Indexed: 02/27/2023] Open
Abstract
Precise control of tissue temperature during Laser-Induced Thermotherapy (LITT) procedures has the potential to improve the clinical efficiency and safety of such minimally invasive therapies. We present a method to automatically regulate in vivo the temperature increase during LITT using real-time rapid volumetric Magnetic Resonance thermometry (8 slices acquired every second, with an in-plane resolution of 1.4 mmx1.4 mm and a slice thickness of 3 mm) using the proton-resonance frequency (PRF) shift technique. The laser output power is adjusted every second using a feedback control algorithm (proportional-integral-derivative controller) to force maximal tissue temperature in the targeted region to follow a predefined temperature-time profile. The root-mean-square of the difference between the target temperature and the measured temperature ranged between 0.5 °C and 1.4 °C, for temperature increases between + 5 °C to + 30 °C above body temperature and a long heating duration (up to 15 min), showing excellent accuracy and stability of the method. These results were obtained on a 1.5 T clinical MRI scanner, showing a potential immediate clinical application of such a temperature controller during MR-guided LITT.
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Abstract
Immunotherapy has revolutionized the treatment of patients with cancer. However, promoting antitumour immunity in patients with tumours that are resistant to these therapies remains a challenge. Thermal therapies provide a promising immune-adjuvant strategy for use with immunotherapy, mostly owing to the capacity to reprogramme the tumour microenvironment through induction of immunogenic cell death, which also promotes the recruitment of endogenous immune cells. Thus, thermal immunotherapeutic strategies for various cancers are an area of considerable research interest. In this Review, we describe the role of the various thermal therapies and provide an update on attempts to combine these with immunotherapies in clinical trials. We also provide an overview of the preclinical development of various thermal immuno-nanomedicines, which are capable of combining thermal therapies with various immunotherapy strategies in a single therapeutic platform. Finally, we discuss the challenges associated with the clinical translation of thermal immuno-nanomedicines and emphasize the importance of multidisciplinary and inter-professional collaboration to facilitate the optimal translation of this technology from bench to bedside.
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15
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Hamade YJ, Mehrotra A, Chen CC. Stereotactic needle biopsy and laser ablation of geographically distinct lesions through a novel magnetic resonance imaging-compatible cranial stereotaxic frame: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2023; 5:CASE22448. [PMID: 36624633 PMCID: PMC9830414 DOI: 10.3171/case22448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 11/17/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Current technologies that support stereotactic laser ablation (SLA) of geographically distinct lesions require placement of multiple bolts or time-consuming, intertrajectory adjustments. OBSERVATIONS Two geographically distinct nodular lesions were safely biopsied and laser ablated in a 62-year-old woman with recurrent glioblastoma using the ClearPoint Array frame, a novel magnetic resonance imaging-compatible stereotactic frame designed to support independent parallel trajectories without intertrajectory frame adjustment. LESSONS Here, the authors provide a proof-of-principle case report demonstrating that geographically distinct lesions can be safely biopsied and ablated through parallel trajectories supported by the ClearPoint Array frame without intertrajectory adjustment.
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Affiliation(s)
- Youssef J. Hamade
- Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota; and
| | - Avanti Mehrotra
- Department of Oncology, North Memorial Health, Minneapolis, Minnesota
| | - Clark C. Chen
- Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota; and
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16
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Muacevic A, Adler JR, Patra S, Mazaris P. Laser Interstitial Thermal Therapy for the Treatment of a Pineal Region Glioma Through an Infratentorial Approach: A Case Report. Cureus 2023; 15:e33607. [PMID: 36788905 PMCID: PMC9910817 DOI: 10.7759/cureus.33607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2023] [Indexed: 01/12/2023] Open
Abstract
Laser interstitial thermal therapy (LITT) is a minimally invasive surgical option for the treatment of brain tumors introduced in 1983. The innovative technique was welcomed for its ability to access deep-seated supratentorial and posterior cranial fossa lesions. Surgical approaches to pineal region tumors are challenging and require a high degree of precision since the critical vasculature, such as the vein of Galen and precentral vein, in the area pose significant anatomical challenges to operating surgeons. To minimize the risk of damaging this key venous anatomy, an infratentorial approach may be more advantageous. We present a case where LITT was utilized through an infratentorial approach to a pineal region tumor. A 62-year-old male with no significant past medical history presented to his primary care physician complaining of ataxia and headaches for the past four weeks. An MRI was concerning for multicentric glioma within the cerebellar hemispheres, brainstem extending to the middle cerebellar peduncle, upper cervical spinal cord, and pineal region. An enhancing lesion of the midbrain tectum was concerning for a high-grade tumor. We decided to proceed with stereotactic biopsy and magnetic resonance-guided LITT via an infratentorial approach. Supratentorial trajectory planning did not allow for a safe corridor due to the venous anatomy; thus, it was decided to proceed with an infratentorial approach. The patient was positioned prone, had his bone fiducial CT fused with MRI, and the tumor was targeted using robotic guidance (ROSA, Zimmer Biomet, Warsaw, Indiana). Postoperatively, he suffered from transient diplopia due to cranial nerve VI palsy. Additionally, the postoperative MRI revealed a decrease in the size of the enhancing lesion and the hyperintense T2 signal within the brainstem. Open surgical approaches to tumors within the pineal region often pose an anatomic and neurovascular challenge. We describe the safe utilization of a novel, previously unreported infratentorial approach utilizing LITT with promising treatment, morbidity, and efficacy outcomes. A larger series will be necessary to ensure the safety and efficacy of this approach.
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17
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Schupper AJ, Chanenchuk T, Racanelli A, Price G, Hadjipanayis CG. Laser hyperthermia: Past, present, and future. Neuro Oncol 2022; 24:S42-S51. [PMID: 36322099 PMCID: PMC9629480 DOI: 10.1093/neuonc/noac208] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Magnetic resonance imaging-guided laser interstitial thermal therapy (LITT) is an ablative procedure using heat from a laser to provide cytoreduction in tissue. It is a minimally invasive procedure that has been used in intracranial pathologies such as high-grade gliomas, metastatic lesions, epilepsy, and other lesions. While LITT may offer a more acceptable complication profile compared to open surgery, the role of laser therapy for intracranial lesions in current treatment paradigms continues to evolve. This review will focus on the background and application of LITT, the current evidence for its use, and future directions for the technology.
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Affiliation(s)
- Alexander J Schupper
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York, USA
| | - Tori Chanenchuk
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York, USA
| | - Anna Racanelli
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York, USA
| | - Gabrielle Price
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York, USA
| | - Constantinos G Hadjipanayis
- Department of Neurosurgery, Icahn School of Medicine, Mount Sinai Downtown Union Square, Mount Sinai Health System, New York, New York, USA
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18
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Fadel HA, Haider S, Pawloski JA, Zakaria HM, Macki M, Bartlett S, Schultz L, Robin AM, Kalkanis SN, Lee IY. Laser Interstitial Thermal Therapy for First-Line Treatment of Surgically Accessible Recurrent Glioblastoma: Outcomes Compared With a Surgical Cohort. Neurosurgery 2022; 91:701-709. [PMID: 35986677 DOI: 10.1227/neu.0000000000002093] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 06/05/2022] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND Laser interstitial thermal therapy (LITT) for glioblastoma (GBM) has been reserved for poor surgical candidates and deep "inoperable" lesions. We present the first reported series of LITT for surgically accessible recurrent GBM (rGBM) that would otherwise be treated with surgical resection. OBJECTIVE To evaluate the use of LITT for unifocal, lobar, first-time rGBM compared with a similar surgical cohort. METHODS A retrospective institutional database was used to identify patients with unifocal, lobar, first-time rGBM who underwent LITT or resection between 2013 and 2020. Clinical and volumetric lesional characteristics were compared between cohorts. Subgroup analysis of patients with lesions ≤20 cm 3 was also completed. Primary outcomes were overall survival and progression-free survival. RESULTS Of the 744 patients with rGBM treated from 2013 to 2020, a LITT cohort of 17 patients were compared with 23 similar surgical patients. There were no differences in baseline characteristics, although lesions were larger in the surgical cohort (7.54 vs 4.37 cm 3 , P = .017). Despite differences in lesion size, both cohorts had similar extents of ablation/resection (90.7% vs 95.1%, P = .739). Overall survival (14.1 vs 13.8 months, P = .578) and progression-free survival (3.7 vs 3.3 months, P = 0. 495) were similar. LITT patients had significantly shorter hospital stays (2.2 vs 3.0 days, P = .004). Subgroup analysis of patients with lesions ≤20 cm 3 showed similar outcomes, with LITT allowing for significantly shorter hospital stays. CONCLUSION We found no difference in survival outcomes or morbidity between LITT and repeat surgery for surgically accessible rGBM while LITT resulted in shorter hospital stays and more efficient postoperative care.
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Affiliation(s)
- Hassan A Fadel
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Sameah Haider
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Jacob A Pawloski
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Hesham M Zakaria
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Mohamed Macki
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Seamus Bartlett
- Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Lonni Schultz
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
- Department of Public Health Sciences, Henry Ford Hospital, Detroit, Michigan, USA
| | - Adam M Robin
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Steven N Kalkanis
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Ian Y Lee
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
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Bibi Farouk ZI, Jiang S, Yang Z, Umar A. A Brief Insight on Magnetic Resonance Conditional Neurosurgery Robots. Ann Biomed Eng 2022; 50:138-156. [PMID: 34993701 DOI: 10.1007/s10439-021-02891-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 11/08/2021] [Indexed: 12/19/2022]
Abstract
The brain is a delicate organ in the human body that requires extreme care. Brain-related diseases are unavoidable. Perse, neurosurgery is a complicated procedure that demands high precision and accuracy. Developing a surgical robot is a complex task. To date, there are only a handful of neurosurgery robots in the market that distinctly undergo clinical procedures. These robots have exorbitant cost that hinders the utmost care progress in the area as they are unaffordable. This paper looked at the historical perspective and presented insight literature of the magnetic resonance conditional stereotactic neurosurgery robots that find their ways in clinics, abandoning research projects and promising research yet to undergo clinical use. In addition, the study also gives a thorough insight into the advantage of magnetic resonance imaging modalities and magnetic resonance conditional robots and the future challenges in automation use. Image compatibility test data and accuracy results are also examined because they guarantee that these systems work correctly in particular imaging settings. The primary differences between these systems include actuation and control technologies, construction materials, and the degree of freedom. Thus, one system has an advantage over the other.
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Affiliation(s)
- Z I Bibi Farouk
- Mechanical Engineering Department, Tianjin University, No. 135, Yaguan Road, Haihe Education Park, Jinnan District, Tianjin, 300354, China
| | - Shan Jiang
- Mechanical Engineering Department, Tianjin University, No. 135, Yaguan Road, Haihe Education Park, Jinnan District, Tianjin, 300354, China.
| | - Zhiyong Yang
- Mechanical Engineering Department, Tianjin University, No. 135, Yaguan Road, Haihe Education Park, Jinnan District, Tianjin, 300354, China
| | - Abubakar Umar
- Mechanical Engineering Department, Hebei University of Technology, Tianjin, China
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Role of Laser Interstitial Thermal Therapy in the Management of Primary and Metastatic Brain Tumors. Curr Treat Options Oncol 2021; 22:108. [PMID: 34687357 DOI: 10.1007/s11864-021-00912-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2021] [Indexed: 10/20/2022]
Abstract
OPINION STATEMENT Laser interstitial thermal therapy (LITT) is a minimally invasive treatment option for brain tumors including glioblastoma, other primary central nervous system (CNS) neoplasms, metastases, and radiation necrosis. LITT employs a fiber optic coupled laser delivery probe stabilized via stereotaxis to deliver thermal energy that induces coagulative necrosis in tumors to achieve effective cytoreduction. LITT complements surgical resection, radiation treatment, tumor treating fields, and systemic therapy, especially in patients who are high risk for surgical resection due to tumor location in eloquent regions or poor functional status. These factors must be balanced with the increased rate of cerebral edema post LITT compared to surgical resection. LITT has also been shown to induce transient disruption of the blood-brain barrier (BBB), especially in the peritumoral region, which allows for enhanced CNS delivery of anti-neoplastic agents, thus greatly expanding the armamentarium against brain tumors to include highly effective anti-neoplastic agents that have poor BBB penetration. In addition, hyperthermia-induced immunogenic cell death is another secondary side effect of LITT that opens up immunotherapy as an attractive adjuvant treatment for brain tumors. Numerous large studies have demonstrated the safety and efficacy of LITT against various CNS tumors and as the literature continues to grow on this novel technique so will its indications.
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Mian SY, Honey JR, Carnicer-Lombarte A, Barone DG. Large Animal Studies to Reduce the Foreign Body Reaction in Brain-Computer Interfaces: A Systematic Review. BIOSENSORS 2021; 11:275. [PMID: 34436077 PMCID: PMC8392711 DOI: 10.3390/bios11080275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 08/10/2021] [Accepted: 08/11/2021] [Indexed: 01/08/2023]
Abstract
Brain-computer interfaces (BCI) are reliant on the interface between electrodes and neurons to function. The foreign body reaction (FBR) that occurs in response to electrodes in the brain alters this interface and may pollute detected signals, ultimately impeding BCI function. The size of the FBR is influenced by several key factors explored in this review; namely, (a) the size of the animal tested, (b) anatomical location of the BCI, (c) the electrode morphology and coating, (d) the mechanics of electrode insertion, and (e) pharmacological modification (e.g., drug eluting electrodes). Trialing methods to reduce FBR in vivo, particularly in large models, is important to enable further translation in humans, and we systematically reviewed the literature to this effect. The OVID, MEDLINE, EMBASE, SCOPUS and Scholar databases were searched. Compiled results were analysed qualitatively. Out of 8388 yielded articles, 13 were included for analysis, with most excluded studies experimenting on murine models. Cats, rabbits, and a variety of breeds of minipig/marmoset were trialed. On average, over 30% reduction in inflammatory cells of FBR on post mortem histology was noted across intervention groups. Similar strategies to those used in rodent models, including tip modification and flexible and sinusoidal electrode configurations, all produced good effects in histology; however, a notable absence of trials examining the effect on BCI end-function was noted. Future studies should assess whether the reduction in FBR correlates to an improvement in the functional effect of the intended BCI.
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Affiliation(s)
- Shan Yasin Mian
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London SW7 2BX, UK
| | - Jonathan Roy Honey
- School of Clinical Medicine, University of Cambridge, Cambridge CB3 0DF, UK;
| | | | - Damiano Giuseppe Barone
- Centre for Brain Repair, Department of Clinical Neurosciences, University of Cambridge, Cambridge CB3 0DF, UK;
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22
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Kok HP, Cressman ENK, Ceelen W, Brace CL, Ivkov R, Grüll H, Ter Haar G, Wust P, Crezee J. Heating technology for malignant tumors: a review. Int J Hyperthermia 2021; 37:711-741. [PMID: 32579419 DOI: 10.1080/02656736.2020.1779357] [Citation(s) in RCA: 141] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The therapeutic application of heat is very effective in cancer treatment. Both hyperthermia, i.e., heating to 39-45 °C to induce sensitization to radiotherapy and chemotherapy, and thermal ablation, where temperatures beyond 50 °C destroy tumor cells directly are frequently applied in the clinic. Achievement of an effective treatment requires high quality heating equipment, precise thermal dosimetry, and adequate quality assurance. Several types of devices, antennas and heating or power delivery systems have been proposed and developed in recent decades. These vary considerably in technique, heating depth, ability to focus, and in the size of the heating focus. Clinically used heating techniques involve electromagnetic and ultrasonic heating, hyperthermic perfusion and conductive heating. Depending on clinical objectives and available technology, thermal therapies can be subdivided into three broad categories: local, locoregional, or whole body heating. Clinically used local heating techniques include interstitial hyperthermia and ablation, high intensity focused ultrasound (HIFU), scanned focused ultrasound (SFUS), electroporation, nanoparticle heating, intraluminal heating and superficial heating. Locoregional heating techniques include phased array systems, capacitive systems and isolated perfusion. Whole body techniques focus on prevention of heat loss supplemented with energy deposition in the body, e.g., by infrared radiation. This review presents an overview of clinical hyperthermia and ablation devices used for local, locoregional, and whole body therapy. Proven and experimental clinical applications of thermal ablation and hyperthermia are listed. Methods for temperature measurement and the role of treatment planning to control treatments are discussed briefly, as well as future perspectives for heating technology for the treatment of tumors.
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Affiliation(s)
- H Petra Kok
- Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Erik N K Cressman
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Wim Ceelen
- Department of GI Surgery, Ghent University Hospital, Ghent, Belgium
| | - Christopher L Brace
- Department of Radiology and Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Robert Ivkov
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Mechanical Engineering, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, USA.,Department of Materials Science and Engineering, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Holger Grüll
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Gail Ter Haar
- Department of Physics, The Institute of Cancer Research, London, UK
| | - Peter Wust
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Johannes Crezee
- Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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23
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Eichberg DG, Menaker SA, Jermakowicz WJ, Shah AH, Luther EM, Jamshidi AM, Semonche AM, Di L, Komotar RJ, Ivan ME. Multiple Iterations of Magnetic Resonance-Guided Laser Interstitial Thermal Ablation of Brain Metastases: Single Surgeon's Experience and Review of the Literature. Oper Neurosurg (Hagerstown) 2021; 19:195-204. [PMID: 31828344 DOI: 10.1093/ons/opz375] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 09/29/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Prior treatment with magnetic resonance-guided, laser-induced thermal therapy (LITT) is widely assumed not to be a contraindication for further treatment of brain lesions, including further iterations of LITT. However, the safety and efficacy of repeat LITT treatments have never been formally investigated. OBJECTIVE To evaluate treatment with multiple iterations of LITT. METHODS All patients treated with LITT at least twice at our institution were included in the study. Outcomes and neurological examinations from before and after surgery were retrospectively examined from clinic notes. Perilesonal edema was determined at various timepoints using volumetric data derived from manual tracings of fluid-attenuated inversion recovery (FLAIR) enhancement on magnetic resonance imaging (MRI). Finally, a literature review of prior cases of repeat LITT was performed. RESULTS A total of 9 patients underwent 18 treatments with LITT; all but 1 of whom were treated for metastatic brain lesions. One patient had a transient cerebrospinal fluid leak, whereas a second patient had a superficial wound infection, both of which resolved with standard medical care. The remaining 7 patients tolerated all LITT procedures without complication. Analysis of perilesional edema volume demonstrated a correlation with the amount of energy delivered during LITT. Literature review found 5 published papers describing 9 patients who underwent LITT more than once, the majority of whom tolerated repeat LITT well. CONCLUSION LITT is a safe and promising treatment modality and may be used multiple times without issue. There appears to be an association between the amount of energy delivered during a LITT session and the degree of postoperative perilesional edema.
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Affiliation(s)
- Daniel G Eichberg
- Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, Florida
| | - Simon A Menaker
- Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, Florida
| | - Walter J Jermakowicz
- Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, Florida
| | - Ashish H Shah
- Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, Florida
| | - Evan M Luther
- Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, Florida
| | - Aria M Jamshidi
- Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, Florida
| | - Alexa M Semonche
- Department of Neurological Surgery, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
| | - Long Di
- Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Ricardo J Komotar
- Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, Florida
| | - Michael E Ivan
- Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, Florida
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24
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Patel B, Yang PH, Kim AH. The effect of thermal therapy on the blood-brain barrier and blood-tumor barrier. Int J Hyperthermia 2021; 37:35-43. [PMID: 32672118 DOI: 10.1080/02656736.2020.1783461] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The blood-brain and blood-tumor barriers represent highly specialized structures responsible for tight regulation of molecular transit into the central nervous system. Under normal circumstances, the relative impermeability of the blood-brain barrier (BBB) protects the brain from circulating toxins and contributes to a brain microenvironment necessary for optimal neuronal function. However, in the context of tumors and other diseases of central nervous system, the BBB and the more recently appreciated blood-tumor barrier (BTB) represent barriers that prevent effective drug delivery. Overcoming both barriers to optimize treatment of central nervous system diseases remains the subject of intense scientific investigation. Although many newer technologies have been developed to overcome these barriers, thermal therapy, which dates back to the 1890 s, has been known to disrupt the BBB since at least the early 1980s. Recently, as a result of several technological advances, laser interstitial thermal therapy (LITT), a method of delivering targeted thermal therapy, has gained widespread use as a surgical technique to ablate brain tumors. In addition, accumulating evidence indicates that laser ablation may also increase local BBB/BTB permeability after treatment. We herein review the structure and function of the BBB and BTB and the impact of thermal injury, including LITT, on barrier function.
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Affiliation(s)
- Bhuvic Patel
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Peter H Yang
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Albert H Kim
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA
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25
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Laser interstitial thermotherapy (LITT) for the treatment of tumors of the brain and spine: a brief review. J Neurooncol 2021; 151:429-442. [PMID: 33611709 PMCID: PMC7897607 DOI: 10.1007/s11060-020-03652-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 10/15/2020] [Indexed: 12/11/2022]
Abstract
Introduction Laser Interstitial Thermotherapy (LITT; also known as Stereotactic Laser Ablation or SLA), is a minimally invasive treatment modality that has recently gained prominence in the treatment of malignant primary and metastatic brain tumors and radiation necrosis and studies for treatment of spinal metastasis has recently been reported. Methods Here we provide a brief literature review of the various contemporary uses for LITT and their reported outcomes. Results Historically, the primary indication for LITT has been for the treatment of recurrent glioblastoma (GBM). However, indications have continued to expand and now include gliomas of different grades, brain metastasis (BM), radiation necrosis (RN), other types of brain tumors as well as spine metastasis. LITT is emerging as a safe, reliable, minimally invasive clinical approach, particularly for deep seated, focal malignant brain tumors and radiation necrosis. The role of LITT for treatment of other types of tumors of the brain and for spine tumors appears to be evolving at a small number of centers. While the technology appears to be safe and increasingly utilized, there have been few prospective clinical trials and most published studies combine different pathologies in the same report. Conclusion Well-designed prospective trials will be required to firmly establish the role of LITT in the treatment of lesions of the brain and spine.
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26
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Nagaraja TN, Lee IY. Cerebral microcirculation in glioblastoma: A major determinant of diagnosis, resection, and drug delivery. Microcirculation 2021; 28:e12679. [PMID: 33474805 DOI: 10.1111/micc.12679] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 01/12/2021] [Indexed: 12/25/2022]
Abstract
Glioblastoma (GBM) is the most common primary brain tumor with a dismal prognosis. Current standard of treatment is safe maximal tumor resection followed by chemotherapy and radiation. Altered cerebral microcirculation and elevated blood-tumor barrier (BTB) permeability in tumor periphery due to glioma-induced vascular dysregulation allow T1 contrast-enhanced visualization of resectable tumor boundaries. Newer tracers that label the tumor and its vasculature are being increasingly used for intraoperative delineation of glioma boundaries for even more precise resection. Fluorescent 5-aminolevulinic acid (5-ALA) and indocyanine green (ICG) are examples of such intraoperative tracers. Recently, magnetic resonance imaging (MRI)-based MR thermometry is being employed for laser interstitial thermal therapy (LITT) for glioma debulking. However, aggressive, fatal recurrence always occurs. Postsurgical chemotherapy is hampered by the inability of most drugs to cross the blood-brain barrier (BBB). Understanding postsurgical changes in brain microcirculation and permeability is crucial to improve chemotherapy delivery. It is important to understand whether any microcirculatory indices can differentiate between true recurrence and radiation necrosis. LITT leads to peri-ablation BBB opening that persists for several weeks. Whether it can be a conduit for chemotherapy delivery is yet to be explored. This review will address the role of cerebral microcirculation in such emerging ideas in GBM diagnosis and therapy.
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Affiliation(s)
| | - Ian Y Lee
- Department of Neurosurgery, Henry Ford Hospital, Detroit, MI, USA
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27
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Yang PH, Hacker CD, Patel B, Daniel AGS, Leuthardt EC. Resting-State Functional Magnetic Resonance Imaging Networks as a Quantitative Metric for Impact of Neurosurgical Interventions. Front Neurosci 2021; 15:665016. [PMID: 34776836 PMCID: PMC8585791 DOI: 10.3389/fnins.2021.665016] [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] [Received: 02/06/2021] [Accepted: 10/05/2021] [Indexed: 12/02/2022] Open
Abstract
Objective: Resting-state functional MRI (rs-fMRI) has been used to evaluate brain network connectivity as a result of intracranial surgery but has not been used to compare different neurosurgical procedures. Laser interstitial thermal therapy (LITT) is an alternative to conventional craniotomy for the treatment of brain lesions such as tumors and epileptogenic foci. While LITT is thought of as minimally invasive, its effect on the functional organization of the brain is still under active investigation and its impact on network changes compared to conventional craniotomy has not yet been explored. We describe a novel computational method for quantifying and comparing the impact of two neurosurgical procedures on brain functional connectivity. Methods: We used a previously described seed-based correlation analysis to generate resting-state network (RSN) correlation matrices, and compared changes in correlation patterns within and across RSNs between LITT and conventional craniotomy for treatment of 24 patients with singular intracranial tumors at our institution between 2014 and 2017. Specifically, we analyzed the differences in patient-specific changes in the within-hemisphere correlation patterns of the contralesional hemisphere. Results: In a post-operative follow-up period up to 2 years within-hemisphere connectivity of the contralesional hemisphere after surgery was more highly correlated to the pre-operative state in LITT patients when compared to craniotomy patients (P = 0.0287). Moreover, 4 out of 11 individual RSNs demonstrated significantly higher degrees of correlation between pre-operative and post-operative network connectivity in patients who underwent LITT (all P < 0.05). Conclusion: Rs-fMRI may be used as a quantitative metric to determine the impact of different neurosurgical procedures on brain functional connectivity. Global and individual network connectivity in the contralesional hemisphere may be more highly preserved after LITT when compared to craniotomy for the treatment of brain tumors.
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Affiliation(s)
- Peter H Yang
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, United States
| | - Carl D Hacker
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, United States
| | - Bhuvic Patel
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, United States
| | - Andy G S Daniel
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, United States
| | - Eric C Leuthardt
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, United States.,Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, United States.,Department of Neuroscience, Washington University School of Medicine, St. Louis, MO, United States.,Center for Innovation in Neuroscience and Technology, Washington University School of Medicine, St. Louis, MO, United States.,Brain Laser Center, Washington University School of Medicine, St. Louis, MO, United States
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28
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Hajtovic S, Mogilner A, Ard J, Gautreaux JE, Britton H, Fatterpekar G, Young MG, Placantonakis DG. Awake Laser Ablation for Patients With Tumors in Eloquent Brain Areas: Operative Technique and Case Series. Cureus 2020; 12:e12186. [PMID: 33489596 PMCID: PMC7815262 DOI: 10.7759/cureus.12186] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background Magnetic resonance imaging (MRI)-guided laser interstitial thermal therapy (LITT) is a minimally invasive treatment modality that has been gaining traction in neuro-oncology. Laser ablation is a particularly appealing treatment option when eloquent neurologic function at the tumor location precludes conventional surgical excision. Although typically performed under general anesthesia, LITT in awake patients may help monitor and preserve critical neurologic functions. Objective To describe intraoperative workflow and clinical outcomes in patients undergoing awake laser ablation of brain tumors. Methods We present a cohort of six patients with tumors located in eloquent brain areas that were treated with awake LITT and report three different workflow paradigms involving diagnostic or intraoperative MRI. In all cases, we used NeuroBlate® (Monteris Medical, Plymouth, MN) fiberoptic laser probes for stereotactic laser ablation of tumors. The neurologic status of patients was intermittently assessed every few minutes during the ablation. Results The mean preoperative tumor volume that was targeted was 12.09 ± 3.20 cm3, and the estimated ablation volume was 12.06 ± 2.75 cm3. Performing the procedure in awake patients allowed us close monitoring of neurologic function intraoperatively. There were no surgical complications. The length of stay was one day for all patients except one. Three patients experienced acute or delayed worsening of pre-existing neurologic deficits that responded to corticosteroids. Conclusion We propose that awake LITT is a safe approach when tumors in eloquent brain areas are considered for laser ablation.
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Affiliation(s)
- Sabastian Hajtovic
- Neurosurgery, City University of New York (CUNY) School of Medicine, New York, USA
| | - Alon Mogilner
- Neurological Surgery, New York University (NYU) Grossman School of Medicine, New York, USA
| | - John Ard
- Anesthesiology, New York University (NYU) Grossman School of Medicine, New York, USA
| | | | | | - Girish Fatterpekar
- Radiology, New York University (NYU) Grossman School of Medicine, New York, USA
| | - Matthew G Young
- Radiology, New York University (NYU) Grossman School of Medicine, New York, USA
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29
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Franzini A, Moosa S, Prada F, Elias WJ. Ultrasound Ablation in Neurosurgery: Current Clinical Applications and Future Perspectives. Neurosurgery 2020; 87:1-10. [PMID: 31745558 DOI: 10.1093/neuros/nyz407] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 07/21/2019] [Indexed: 11/14/2022] Open
Abstract
The concept of focusing high-intensity ultrasound beams for the purpose of cerebral ablation has interested neurosurgeons for more than 70 yr. However, the need for a craniectomy or a cranial acoustic window hindered the clinical diffusion of this technique. Recent technological advances, including the development of phased-array transducers and magnetic resonance imaging technology, have rekindled the interest in ultrasound for ablative brain surgery and have led to the development of the transcranial magnetic resonance-guided focused ultrasound (MRgFUS) thermal ablation procedure. In the last decade, this method has become increasingly popular, and its clinical applications are broadening. Despite the demonstrated efficacy of MRgFUS, transcranial thermal ablation using ultrasound is limited in that it can target exclusively the central region of the brain where the multiple acoustic beams are most optimally focused. On the contrary, lesioning of the cortex, the superficial subcortical areas, and regions close to the skull base is not possible with the limited treatment envelope of current phased-array transducers. Therefore, new ultrasound ablative techniques, which are not based on thermal mechanisms, have been developed and tested in experimental settings. This review describes the mechanisms by which these novel, nonthermal ablative techniques are based and also presents the current clinical applications of MRgFUS thermal ablation.
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Affiliation(s)
- Andrea Franzini
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia.,Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Shayan Moosa
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Francesco Prada
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia.,Focused Ultrasound Foundation, Charlottesville, Virginia
| | - W Jeffrey Elias
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
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30
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de Franca SA, Tavares WM, Salinet ASM, Teixeira MJ, Paiva WS. Laser interstitial thermal therapy as an adjunct therapy in brain tumors: A meta-analysis and comparison with stereotactic radiotherapy. Surg Neurol Int 2020; 11:360. [PMID: 33194293 PMCID: PMC7656052 DOI: 10.25259/sni_152_2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 10/01/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Minimally invasive procedures are gaining widespread acceptance in difficult-to-access brain tumor treatment. Stereotactic radiosurgery (SRS) is the preferred choice, however, laser interstitial thermal therapy (LITT) has emerged as a tumor cytoreduction technique. The present meta-analysis compared current SRS therapy with LITT in brain tumors. METHODS A search was performed in Lilacs, PubMed, and Cochrane database. Patient's demographics, tumor location, therapy used, Karnofsky performance status score before treatment, and patient's outcome (median overall survival, progression-free survival, and adverse events) data were extracted from studies. The risk of bias was assessed by Cochrane collaboration tool. RESULTS Twenty-five studies were included in this meta-analysis. LITT and SRS MOS in brain metastasis patients were 12.8 months' versus 9.8 months (ranges 9.3-16.3 and 8.3-9.8; P = 0.02), respectively. In a combined comparison of adverse effects among LITT versus SRS in brain metastasis, we found 15% reduction in absolute risk difference (-0.16; 95% confidence interval P < 0.0001). CONCLUSION We could not state that LITT treatment is an optimal alternative therapy for difficult-to-access brain tumors due to the lack of systematic data that were reported in our pooled studies. However, our results identified a positive effect in lowering the absolute risk of adverse events compared with SRS therapy. Therefore, randomized trials are encouraged to ascertain LITT role, as upfront or postoperative/post-SRS therapy for brain tumor treatment.
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Affiliation(s)
| | - Wagner Malago Tavares
- Department of Research, Instituto Paulista De Saude Para Alta Complexidade, Brazil
- Institute of Neurology, University of São Paulo, São Paulo, Brazil
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31
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Stylli SS. Novel Treatment Strategies for Glioblastoma. Cancers (Basel) 2020; 12:cancers12102883. [PMID: 33049911 PMCID: PMC7599818 DOI: 10.3390/cancers12102883] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 10/06/2020] [Indexed: 12/12/2022] Open
Abstract
Glioblastoma (GBM) is the most common primary central nervous system tumor in adults. It is a highly invasive disease, making it difficult to achieve a complete surgical resection, resulting in poor prognosis with a median survival of 12–15 months after diagnosis, and less than 5% of patients survive more than 5 years. Surgical, instrument technology, diagnostic and radio/chemotherapeutic strategies have slowly evolved over time, but this has not translated into significant increases in patient survival. The current standard of care for GBM patients involving surgery, radiotherapy, and concomitant chemotherapy temozolomide (known as the Stupp protocol), has only provided a modest increase of 2.5 months in median survival, since the landmark publication in 2005. There has been considerable effort in recent years to increase our knowledge of the molecular landscape of GBM through advances in technology such as next-generation sequencing, which has led to the stratification of the disease into several genetic subtypes. Current treatments are far from satisfactory, and studies investigating acquired/inherent resistance to current therapies, restricted drug delivery, inter/intra-tumoral heterogeneity, drug repurposing and a tumor immune-evasive environment have been the focus of intense research over recent years. While the clinical advancement of GBM therapeutics has seen limited progression compared to other cancers, developments in novel treatment strategies that are being investigated are displaying encouraging signs for combating this disease. This aim of this editorial is to provide a brief overview of a select number of these novel therapeutic approaches.
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Affiliation(s)
- Stanley S. Stylli
- Department of Surgery, The University of Melbourne, The Royal Melbourne Hospital, Parkville, VIC 3050, Australia; or
- Department of Neurosurgery, The Royal Melbourne Hospital, Parkville, VIC 3050, Australia
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32
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Patel NA, Nycz CJ, Carvalho PA, Gandomi KY, Gondokaryono R, Li G, Heffter T, Burdette EC, Pilitsis JG, Fischer GS. An Integrated Robotic System for MRI-Guided Neuroablation: Preclinical Evaluation. IEEE Trans Biomed Eng 2020; 67:2990-2999. [PMID: 32078530 PMCID: PMC7529397 DOI: 10.1109/tbme.2020.2974583] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Treatment of brain tumors requires high precision in order to ensure sufficient treatment while minimizing damage to surrounding healthy tissue. Ablation of such tumors using needle-based therapeutic ultrasound (NBTU) under real-time magnetic resonance imaging (MRI) can fulfill this need. However, the constrained space and strong magnetic field in the MRI bore restricts patient access limiting precise placement of the NBTU ablation tool. A surgical robot compatible with use inside the bore of an MRI scanner can alleviate these challenges. METHODS We present preclinical trials of a robotic system for NBTU ablation of brain tumors under real-time MRI guidance. The system comprises of an updated robotic manipulator and corresponding control electronics, the NBTU ablation system and applications for planning, navigation and monitoring of the system. RESULTS The robotic system had a mean translational and rotational accuracy of 1.39 ± 0.64 mm and 1.27 [Formula: see text] in gelatin phantoms and 3.13 ± 1.41 mm and 5.58 [Formula: see text] in 10 porcine trials while causing a maximum reduction in signal to noise ratio (SNR) of 10.3%. CONCLUSION The integrated robotic system can place NBTU ablator at a desired target location in porcine brain and monitor the ablation in realtime via magnetic resonance thermal imaging (MRTI). SIGNIFICANCE Further optimization of this system could result in a clinically viable system for use in human trials for various diagnostic or therapeutic neurosurgical interventions.
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33
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Ashikbayeva Z, Aitkulov A, Jelbuldina M, Issatayeva A, Beisenova A, Molardi C, Saccomandi P, Blanc W, Inglezakis VJ, Tosi D. Distributed 2D temperature sensing during nanoparticles assisted laser ablation by means of high-scattering fiber sensors. Sci Rep 2020; 10:12593. [PMID: 32724053 PMCID: PMC7387462 DOI: 10.1038/s41598-020-69384-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 07/10/2020] [Indexed: 12/13/2022] Open
Abstract
The high demand in effective and minimally invasive cancer treatments, namely thermal ablation, leads to the demand for real-time multi-dimensional thermometry to evaluate the treatment effectiveness, which can be also assisted by the use of nanoparticles. We report the results of 20-nm gold and magnetic iron oxide nanoparticles-assisted laser ablation on a porcine liver phantom. The experimental set-up consisting of high-scattering nanoparticle-doped fibers was operated by means of a scattering-level multiplexing arrangement and interrogated via optical backscattered reflectometry, together with a solid-state laser diode operating at 980 nm. The multiplexed 2-dimensional fiber arrangement based on nanoparticle-doped fibers allowed an accurate superficial thermal map detected in real-time.
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Affiliation(s)
- Zhannat Ashikbayeva
- School of Engineering and Digital Sciences, Nazarbayev University, 53 Kabanbay Batyr Ave, 010000, Nur-Sultan, Kazakhstan.
- PI National Laboratory Astana, Nazarbayev University, 53 Kabanbay Batyr Ave, 010000, Nur-Sultan, Kazakhstan.
| | - Arman Aitkulov
- School of Engineering and Digital Sciences, Nazarbayev University, 53 Kabanbay Batyr Ave, 010000, Nur-Sultan, Kazakhstan
| | - Madina Jelbuldina
- School of Engineering and Digital Sciences, Nazarbayev University, 53 Kabanbay Batyr Ave, 010000, Nur-Sultan, Kazakhstan
| | - Aizhan Issatayeva
- School of Engineering and Digital Sciences, Nazarbayev University, 53 Kabanbay Batyr Ave, 010000, Nur-Sultan, Kazakhstan
| | - Aidana Beisenova
- School of Engineering and Digital Sciences, Nazarbayev University, 53 Kabanbay Batyr Ave, 010000, Nur-Sultan, Kazakhstan
| | - Carlo Molardi
- School of Engineering and Digital Sciences, Nazarbayev University, 53 Kabanbay Batyr Ave, 010000, Nur-Sultan, Kazakhstan
| | - Paola Saccomandi
- Department of Mechanical Engineering, Politecnico Di Milano, Via Giuseppe La Masa 1, 20156, Milan, Italy
| | - Wilfried Blanc
- CNRS, INPHYNI, UMR 7010, Université Côte D'Azur, Parc Valrose, 06108, Nice, France
| | - Vassilis J Inglezakis
- School of Engineering and Digital Sciences, Nazarbayev University, 53 Kabanbay Batyr Ave, 010000, Nur-Sultan, Kazakhstan
- Department of Chemical and Process Engineering, University of Strathclyde, 75 Montrose Street, Glasgow, G1 1XJ, UK
| | - Daniele Tosi
- School of Engineering and Digital Sciences, Nazarbayev University, 53 Kabanbay Batyr Ave, 010000, Nur-Sultan, Kazakhstan
- PI National Laboratory Astana, Nazarbayev University, 53 Kabanbay Batyr Ave, 010000, Nur-Sultan, Kazakhstan
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Mahammedi A, Bachir S, Escott EJ, Barnett GH, Mohammadi AM, Larvie M. Prediction of recurrent glioblastoma after laser interstitial thermal therapy: The role of diffusion imaging. Neurooncol Adv 2020; 1:vdz021. [PMID: 32642657 PMCID: PMC7212867 DOI: 10.1093/noajnl/vdz021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Evaluate the utility of diffusion-weighted imaging (DWI) for the assessment of local recurrence of glioblastoma (GBM) on imaging performed 24 h following MRI-guided laser interstitial thermal therapy (LITT). We hypothesize that microscopic peritumoral infiltration correlates with early subtle variations on DWI images and apparent diffusion coefficient (ADC) maps. Methods Of 64 patients with GBM treated with LITT, 39 had MRI scans within 24 h after undergoing LITT. Patterns on DWI images and ADC maps 24 h following LITT were correlated with areas of future GBM recurrence identified through coregistration of subsequent MRI examinations. In the areas of suspected recurrence within the periphery of post-LITT lesions, signal intensity values on ADC maps were recorded and compared with the remaining peritumoral ring. Results Thirty-nine patients with GBM met the inclusion criteria. For predicting recurrent GBM, areas of decreased DWI signal and increased signal on ADC maps within the expected peritumoral ring of restricted diffusion identified 24 h following LITT showed 86.1% sensitivity, 75.2% specificity, and high correlation (r = 0.53) with future areas of GBM recurrence (P < .01). Areas of future recurrence demonstrated a 37% increase in the ADC value (P < .001), compared with findings in the surrounding treated peritumoral region. A significantly greater area under the receiver operating characteristics curve was determined for ADC values (P < .01). Conclusions DWI obtained 24 h following LITT can help predict the location of GBM recurrence months before the development of abnormal enhancement. This may alter future treatment planning, perhaps suggesting areas that may be targeted for additional therapy.
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Affiliation(s)
| | - Suha Bachir
- Department of Pediatrics and Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Edward J Escott
- Department of Radiology, University of Kentucky, Lexington, Kentucky
| | - Gene H Barnett
- Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio.,Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
| | - Alireza M Mohammadi
- Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio.,Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
| | - Mykol Larvie
- Department of Radiology, Cleveland Clinic, Cleveland, Ohio
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Skandalakis GP, Rivera DR, Rizea CD, Bouras A, Raj JGJ, Bozec D, Hadjipanayis CG. Hyperthermia treatment advances for brain tumors. Int J Hyperthermia 2020; 37:3-19. [PMID: 32672123 PMCID: PMC7756245 DOI: 10.1080/02656736.2020.1772512] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 04/15/2020] [Accepted: 05/16/2020] [Indexed: 02/06/2023] Open
Abstract
Hyperthermia therapy (HT) of cancer is a well-known treatment approach. With the advent of new technologies, HT approaches are now important for the treatment of brain tumors. We review current clinical applications of HT in neuro-oncology and ongoing preclinical research aiming to advance HT approaches to clinical practice. Laser interstitial thermal therapy (LITT) is currently the most widely utilized thermal ablation approach in clinical practice mainly for the treatment of recurrent or deep-seated tumors in the brain. Magnetic hyperthermia therapy (MHT), which relies on the use of magnetic nanoparticles (MNPs) and alternating magnetic fields (AMFs), is a new quite promising HT treatment approach for brain tumors. Initial MHT clinical studies in combination with fractionated radiation therapy (RT) in patients have been completed in Europe with encouraging results. Another combination treatment with HT that warrants further investigation is immunotherapy. HT approaches for brain tumors will continue to a play an important role in neuro-oncology.
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Affiliation(s)
- Georgios P. Skandalakis
- Brain Tumor Nanotechnology Laboratory, Department of Neurosurgery, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Daniel R. Rivera
- Brain Tumor Nanotechnology Laboratory, Department of Neurosurgery, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Caroline D. Rizea
- Brain Tumor Nanotechnology Laboratory, Department of Neurosurgery, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Alexandros Bouras
- Brain Tumor Nanotechnology Laboratory, Department of Neurosurgery, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Joe Gerald Jesu Raj
- Brain Tumor Nanotechnology Laboratory, Department of Neurosurgery, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Dominique Bozec
- Brain Tumor Nanotechnology Laboratory, Department of Neurosurgery, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Constantinos G. Hadjipanayis
- Brain Tumor Nanotechnology Laboratory, Department of Neurosurgery, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
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Montemurro N, Anania Y, Cagnazzo F, Perrini P. Survival outcomes in patients with recurrent glioblastoma treated with Laser Interstitial Thermal Therapy (LITT): A systematic review. Clin Neurol Neurosurg 2020; 195:105942. [PMID: 32470780 DOI: 10.1016/j.clineuro.2020.105942] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/14/2020] [Accepted: 05/17/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To study the role of laser interstitial thermal therapy in recurrent glioblastoma and to assess its effect in the overall survival and in progression-free survival. METHODS A MEDLINE and Pubmed search was performed for the key words "laser interstitial thermal therapy", "LITT" and "glioblastoma". Studies investigating overall survival and progression-free survival of recurrent glioblastoma after laser interstitial thermal therapy were selected. RESULTS A total of 17 studies met the selection criteria, accounting for 203 patients with recurrent glioblastoma who underwent 219 laser interstitial thermal therapy treatments. The median age was 57.4 years and there was male predominance (65.8 % male Vs 34.2 % female). The most common location resulted frontal lobe (29 %), followed by temporal (23.9 %), parietal (21.4 %) and occipital lobes (2.6 %). Additional locations included thalamus, corpus callosum and cerebellum (23.1 %). Pre-treatment median tumor size was 8.9 cm3. Morbidity was 6.4 % with a median hospital stay of 3.5 days. The most common complications were seizures (2%), motor deficits (1.5 %), wound infection (1.5 %), transient hemiparesis (1%) and hemorrhage (0.5 %). No deaths were reported due to LITT procedure. The median progression-free survival and the median overall survival after laser interstitial thermal therapy resulted 5.6 months and 10.2 months, respectively. The median overall survival from diagnosis was 14.7 months. All patients underwent adjuvant chemotherapy after treatment. CONCLUSION Laser interstitial thermal therapy provides an effective treatment with low morbidity for selected patients harboring recurrent glioblastoma. Laser interstitial thermal therapy should be included in the armamentarium of neurosurgical oncologist for treatment of recurrent glioblastomas.
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Affiliation(s)
- Nicola Montemurro
- Department of Neurosurgery, Azienda Ospedaliera Universitaria Pisana (AOUP), Pisa, Italy; Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.
| | - Yury Anania
- Department of Neurosurgery, Azienda Ospedaliera Universitaria Pisana (AOUP), Pisa, Italy
| | - Federico Cagnazzo
- Neuroradiology Department, CHRU Gui de Chauliac, Montpellier, France
| | - Paolo Perrini
- Department of Neurosurgery, Azienda Ospedaliera Universitaria Pisana (AOUP), Pisa, Italy; Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
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Shao J, Radakovich NR, Grabowski M, Borghei-Razavi H, Knusel K, Joshi KC, Muhsen BA, Hwang L, Barnett GH, Mohammadi AM. Lessons Learned in Using Laser Interstitial Thermal Therapy for Treatment of Brain Tumors: A Case Series of 238 Patients from a Single Institution. World Neurosurg 2020; 139:e345-e354. [PMID: 32298824 DOI: 10.1016/j.wneu.2020.03.213] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 03/29/2020] [Accepted: 03/30/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Laser interstitial thermal therapy (LITT) is a novel, minimally invasive alternative to craniotomy, and as with any new technology, comes with a learning curve. OBJECTIVE We present our experience detailing the evolution of this technology in our practice in one of the largest patient cohorts to date regarding LITT in neuro-oncology. METHODS We reviewed 238 consecutive patients with brain tumor treated with LITT at our institution. Data on patient, surgery and tumor characteristics, and follow-up were collected. Patients were categorized into 2 cohorts: early (<2014, 100 patients) and recent (>2015, 138 patients). Median follow-up for the entire cohort was 8.4 months. RESULTS The indications for LITT included gliomas (70.2%), radiation necrosis (21.0%), and metastasis (8.8%). Patient demographics stayed consistent between the 2 cohorts, with the exception of age (early, 54.3; recent, 58.4; P = 0.04). Operative time (6.6 vs. 3.5; P < 0.001) and number of trajectories (53.1% vs. 77.9% with 1 trajectory; P < 0.001) also decreased in the recent cohort. There was a significant decrease in permanent motor deficits over time (15.5 vs. 4.4%; P = 0.005) and 30-day mortality (4.1% vs. 1.5%) also decreased (not statistically significant) in the recent cohort. In terms of clinical outcomes, poor preoperative Karnofsky Performance Status (≤70) were significantly correlated with increased permanent deficits (P = 0.001) and decreased overall survival (P < 0.001 for all time points). CONCLUSIONS We observed improvement in operative efficiency and permanent deficits over time and also patients with poor preoperative Karnofsky Performance Status achieved suboptimal outcomes with LITT. As many other treatment modalities, patient selection is important in this procedure.
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Affiliation(s)
- Jianning Shao
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA; Case Western School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Nathan R Radakovich
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA; Case Western School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Matthew Grabowski
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Hamid Borghei-Razavi
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Konrad Knusel
- Case Western School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Krishna C Joshi
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Baha'eddin A Muhsen
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA; Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - Lee Hwang
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Gene H Barnett
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA; Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA; Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - Alireza M Mohammadi
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA; Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA; Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio, USA.
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Mohammadi AM, Sharma M, Beaumont TL, Juarez KO, Kemeny H, Dechant C, Seas A, Sarmey N, Lee BS, Jia X, Fecci PE, Baehring J, Moliterno J, Chiang VL, Ahluwalia MS, Kim AH, Barnett GH, Leuthardt EC. Upfront Magnetic Resonance Imaging-Guided Stereotactic Laser-Ablation in Newly Diagnosed Glioblastoma: A Multicenter Review of Survival Outcomes Compared to a Matched Cohort of Biopsy-Only Patients. Neurosurgery 2020; 85:762-772. [PMID: 30476325 DOI: 10.1093/neuros/nyy449] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 08/21/2018] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Laser ablation (LA) is used as an upfront treatment in patients with deep seated newly diagnosed Glioblastoma (nGBM). OBJECTIVE To evaluate the outcomes of LA in patients with nGBM and compare them with a matched biopsy-only cohort. METHODS Twenty-four nGBM patients underwent upfront LA at Cleveland clinic, Washington University in St. Louis, and Yale University (6/2011-12/2014) followed by chemo/radiotherapy. Also, 24 out of 171 nGBM patients with biopsy followed by chemo/radiotherapy were matched based on age (< 70 vs ≥ 70), gender, tumor location (deep vs lobar), and volume (<11 cc vs ≥11 cc). Progression-free survival (PFS), overall survival (OS), and disease-specific PFS and OS were outcome measures. Three prognostic groups were identified based on extent of tumor ablation by thermal-damage-threshold (TDT)-lines. RESULTS The median tumor volume in LA (n = 24) and biopsy only (n = 24) groups was 9.3 cm3 and 8.2 cm3 respectively. Overall, median estimate of OS and PFS in LA cohort was 14.4 and 4.3 mo compared to 15.8 mo and 5.9 mo for biopsy only cohort. On multivariate analysis, favorable TDT-line prognostic groups were associated with lower incidence of disease specific death (P = .03) and progression (P = .05) compared to other groups including biopsy only cohort. Only age (<70 yr, P = .02) and tumor volume (<11 cc, P = .03) were favorable prognostic factors for OS. CONCLUSION The maximum tumor coverage by LA followed by radiation/chemotherapy is an effective treatment modality in patients with nGBM, compared to biopsy only cohort. The TDT-line prognostic groups were independent predictor of disease specific death and progression after LA.
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Affiliation(s)
- Alireza M Mohammadi
- The Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Department of Neurosurgery, Neurological Institute, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
| | - Mayur Sharma
- The Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Department of Neurosurgery, Neurological Institute, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
| | - Thomas L Beaumont
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri
| | - Kevin O Juarez
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut
| | - Hanna Kemeny
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina
| | - Cosette Dechant
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina
| | - Andreas Seas
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina
| | - Nehaw Sarmey
- The Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Department of Neurosurgery, Neurological Institute, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
| | - Bryan S Lee
- The Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Department of Neurosurgery, Neurological Institute, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
| | - Xuefei Jia
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Peter E Fecci
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina
| | - Joachim Baehring
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut
| | - Jennifer Moliterno
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut
| | - Veronica L Chiang
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut
| | - Manmeet S Ahluwalia
- The Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Department of Neurosurgery, Neurological Institute, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
| | - Albert H Kim
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri
| | - Gene H Barnett
- The Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Department of Neurosurgery, Neurological Institute, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
| | - Eric C Leuthardt
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri
- Department of Biomedical Engineering, Center for Innovation in Neuroscience and Technology, Washington University School of Medicine, St. Louis, Missouri
- Department of Mechanical Engineering and Material Science, Center for Innovation in Neuroscience and Technology, Washington University, School of Medicine, St. Louis, Missouri
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Arocho-Quinones EV, Lew SM, Handler MH, Tovar-Spinoza Z, Smyth M, Bollo R, Donahue D, Perry MS, Levy ML, Gonda D, Mangano FT, Storm PB, Price AV, Couture DE, Oluigbo C, Duhaime AC, Barnett GH, Muh CR, Sather MD, Fallah A, Wang AC, Bhatia S, Patel K, Tarima S, Graber S, Huckins S, Hafez DM, Rumalla K, Bailey L, Shandley S, Roach A, Alexander E, Jenkins W, Tsering D, Price G, Meola A, Evanoff W, Thompson EM, Brandmeir N. Magnetic resonance-guided stereotactic laser ablation therapy for the treatment of pediatric brain tumors: a multiinstitutional retrospective study. J Neurosurg Pediatr 2020; 26:13-21. [PMID: 32217793 PMCID: PMC7885863 DOI: 10.3171/2020.1.peds19496] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 01/22/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study aimed to assess the safety and efficacy of MR-guided stereotactic laser ablation (SLA) therapy in the treatment of pediatric brain tumors. METHODS Data from 17 North American centers were retrospectively reviewed. Clinical, technical, and radiographic data for pediatric patients treated with SLA for a diagnosis of brain tumor from 2008 to 2016 were collected and analyzed. RESULTS A total of 86 patients (mean age 12.2 ± 4.5 years) with 76 low-grade (I or II) and 10 high-grade (III or IV) tumors were included. Tumor location included lobar (38.4%), deep (45.3%), and cerebellar (16.3%) compartments. The mean follow-up time was 24 months (median 18 months, range 3-72 months). At the last follow-up, the volume of SLA-treated tumors had decreased in 80.6% of patients with follow-up data. Patients with high-grade tumors were more likely to have an unchanged or larger tumor size after SLA treatment than those with low-grade tumors (OR 7.49, p = 0.0364). Subsequent surgery and adjuvant treatment were not required after SLA treatment in 90.4% and 86.7% of patients, respectively. Patients with high-grade tumors were more likely to receive subsequent surgery (OR 2.25, p = 0.4957) and adjuvant treatment (OR 3.77, p = 0.1711) after SLA therapy, without reaching significance. A total of 29 acute complications in 23 patients were reported and included malpositioned catheters (n = 3), intracranial hemorrhages (n = 2), transient neurological deficits (n = 11), permanent neurological deficits (n = 5), symptomatic perilesional edema (n = 2), hydrocephalus (n = 4), and death (n = 2). On long-term follow-up, 3 patients were reported to have worsened neuropsychological test results. Pre-SLA tumor volume, tumor location, number of laser trajectories, and number of lesions created did not result in a significantly increased risk of complications; however, the odds of complications increased by 14% (OR 1.14, p = 0.0159) with every 1-cm3 increase in the volume of the lesion created. CONCLUSIONS SLA is an effective, minimally invasive treatment option for pediatric brain tumors, although it is not without risks. Limiting the volume of the generated thermal lesion may help decrease the incidence of complications.
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Affiliation(s)
| | - Sean M. Lew
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin,Department of Neurosurgery, Children’s Hospital of Wisconsin, Milwaukee, Wisconsin
| | - Michael H. Handler
- Department of Neurosurgery, Children’s Hospital Colorado, Aurora, Colorado
| | - Zulma Tovar-Spinoza
- Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, New York
| | - Matthew Smyth
- Department of Neurosurgery, St. Louis Children’s Hospital, St. Louis, Missouri
| | - Robert Bollo
- Department of Neurosurgery, Primary Children’s Hospital, Salt Lake City, Utah
| | - David Donahue
- Department of Neurosurgery, Cook Children’s Hospital, Fort Worth, Texas
| | - M. Scott Perry
- Department of Neurology, Cook Children’s Hospital, Fort Worth, Texas
| | - Michael L. Levy
- Department of Neurosurgery, Rady Children’s Hospital-San Diego, California
| | - David Gonda
- Department of Neurosurgery, Rady Children’s Hospital-San Diego, California
| | | | - Phillip B. Storm
- Department of Neurosurgery, Children’s Hospital of Philadelphia, Pennsylvania
| | - Angela V. Price
- Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Daniel E. Couture
- Department of Neurosurgery, Wake Forest Baptist Health, Winston-Salem, North Carolina
| | - Chima Oluigbo
- Department of Neurosurgery, Children’s National Health System, Washington, DC
| | - Ann-Christine Duhaime
- Department of Neurosurgery, Massachusetts General Hospital for Children, Boston, Massachusetts
| | - Gene H. Barnett
- Department of Neurosurgery, Cleveland Clinic Children’s, Cleveland, Ohio
| | - Carrie R. Muh
- Department of Neurosurgery, Duke Children’s Hospital, Durham, North Carolina
| | - Michael D. Sather
- Department of Neurosurgery, Penn State Health, Hershey, Pennsylvania
| | - Aria Fallah
- Department of Neurosurgery, UCLA Mattel Children’s Hospital, Los Angeles, California
| | - Anthony C. Wang
- Department of Neurosurgery, UCLA Mattel Children’s Hospital, Los Angeles, California
| | - Sanjiv Bhatia
- Department of Neurosurgery, Nicklaus Children’s Hospital, Miami, Florida
| | - Kadam Patel
- Department of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Sergey Tarima
- Department of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Sarah Graber
- Department of Neurosurgery, Children’s Hospital Colorado, Aurora, Colorado
| | - Sean Huckins
- Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, New York
| | - Daniel M. Hafez
- Department of Neurosurgery, St. Louis Children’s Hospital, St. Louis, Missouri
| | - Kavelin Rumalla
- Department of Neurosurgery, St. Louis Children’s Hospital, St. Louis, Missouri
| | - Laurie Bailey
- Department of Neurosurgery, Cook Children’s Hospital, Fort Worth, Texas
| | - Sabrina Shandley
- Department of Neurosurgery, Cook Children’s Hospital, Fort Worth, Texas
| | - Ashton Roach
- Department of Neurosurgery, Cincinnati Children’s Hospital, Cincinnati, Ohio
| | - Erin Alexander
- Department of Neurosurgery, Children’s Hospital of Philadelphia, Pennsylvania
| | - Wendy Jenkins
- Department of Neurosurgery, Wake Forest Baptist Health, Winston-Salem, North Carolina
| | - Deki Tsering
- Department of Neurosurgery, Children’s National Health System, Washington, DC
| | - George Price
- Department of Neurosurgery, Massachusetts General Hospital for Children, Boston, Massachusetts
| | - Antonio Meola
- Department of Neurosurgery, Cleveland Clinic Children’s, Cleveland, Ohio
| | - Wendi Evanoff
- Department of Neurosurgery, Cleveland Clinic Children’s, Cleveland, Ohio
| | - Eric M. Thompson
- Department of Neurosurgery, Duke Children’s Hospital, Durham, North Carolina
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Bozinov O, Yang Y, Oertel MF, Neidert MC, Nakaji P. Laser interstitial thermal therapy in gliomas. Cancer Lett 2020; 474:151-157. [PMID: 31991153 DOI: 10.1016/j.canlet.2020.01.024] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 01/16/2020] [Accepted: 01/22/2020] [Indexed: 12/14/2022]
Abstract
Laser interstitial thermal therapy (LITT) has been used for brain metastasis, epilepsy, and necrosis, as well as gliomas as a minimally invasive treatment for many years. With the improvement of the thermal monitoring and ablation precision, especially the application of magnetic resonance (MR) thermography in the procedure and the available two commercial laser systems nowadays, LITT is gradually accepted by more neurosurgical centers. Recently, some new concepts, for example the adjuvant chemotherapy or radiation following LITT, the combination of immunotherapy and LITT regarding the glioma treatment are proposed and currently being investigated. The aim of this study is to summarize the evolution of LITT especially for brain gliomas and a possible outlook of the future.
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Affiliation(s)
- Oliver Bozinov
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8002, Zurich, Switzerland.
| | - Yang Yang
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8002, Zurich, Switzerland
| | - Markus F Oertel
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8002, Zurich, Switzerland
| | - Marian C Neidert
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8002, Zurich, Switzerland; Department of Pathology and Center for Cancer Research, Massachusetts General Hospital and Harvard Medical School, Boston, MA, 02114, USA; Broad Institute of Harvard and MIT, Cambridge, MA, 02142, USA
| | - Peter Nakaji
- Department of Neurosurgery, University of Arizona College of Medicine Phoenix, Banner Health, 755 East McDowell Road, Phoenix, AZ, 85006, USA
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Wu D, Li G, Patel N, Yan J, Kim GH, Monfaredi R, Cleary K, Iordachita I. Remotely Actuated Needle Driving Device for MRI-Guided Percutaneous Interventions: Force and Accuracy Evaluation .. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:1985-1989. [PMID: 31946289 DOI: 10.1109/embc.2019.8857260] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This paper presents a 2 degrees-of-freedom (DOF) remotely actuated needle driving device for Magnetic Resonance Imaging (MRI) guided pain injections. The device is evaluated in phantom studies under real-time MRI guidance. The force and torque asserted by the device on the 4-DOF base robot are measured. The needle driving device consists of a needle driver, a 1.2-meter long beaded chain transmission, an actuation box, a robot controller and a Graphical User Interface (GUI). The needle driver can fit within a typical MRI scanner bore and is remotely actuated at the end of the MRI table through a novel beaded chain transmission. The remote actuation mechanism significantly reduces the weight and size of the needle driver at the patient end as well as the artifacts introduced by the motors. The clinician can manually steer the needle by rotating the knobs on the actuation box or remotely through a software interface in the MRI console room. The force and torque resulting from the needle driver in various configurations both in static and dynamic status were measured and reported. An accuracy experiment in the MRI environment under real-time image feedback demonstrates a small mean targeting error (<; 1.5 mm) in a phantom study.
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Khalkhal E, Rezaei-Tavirani M, Zali MR, Akbari Z. The Evaluation of Laser Application in Surgery: A Review Article. J Lasers Med Sci 2019; 10:S104-S111. [PMID: 32021682 DOI: 10.15171/jlms.2019.s18] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
There are several types of surgeries which use lasers in the operating room. Surgeons use lasers in general surgery or surgical specialties to cut, coagulate, and remove tissue. In modern medicine, the application of laser therapy is an attractive subject due to its minimal invasive effect. Today lasers are widely used in the treatment and diagnosis of many diseases such as various cancers, lithotripsy, ophthalmology, as well as dermatology and beauty procedures. Depending on the type of lasers, the wavelength and the delivery system, most lasers have replaced conventional surgical instruments for better wound healing results. Over time, by using many different tools and devices, new lasers have been created; as a result, they are used in a wide range of medical special cases. In this review, laser applications in surgery and its beneficial effects compared to previous surgeries with the aim of providing appropriate therapeutic and non-invasive solutions with minimal side effects after surgery are investigated.
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Affiliation(s)
- Ensieh Khalkhal
- Proteomics Research Center, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Mohammad Reza Zali
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Akbari
- Laser Application in Medical Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Laurent D, Oliveria SF, Shang M, Bova F, Freedman R, Rahman M. Techniques to Ensure Accurate Targeting for Delivery of Awake Laser Interstitial Thermotherapy. Oper Neurosurg (Hagerstown) 2019; 15:454-460. [PMID: 29444286 DOI: 10.1093/ons/opx290] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 12/23/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Magnetic resonance imaging (MRI) guided laser interstitial thermal therapy (LITT) is an emerging neurosurgical treatment modality that is typically performed under general anesthesia. We describe a novel workflow developed at the University of Florida to deliver LITT in conscious patients without the use of general anesthesia. OBJECTIVE To describe a novel workflow for LITT implementation in the awake patient with equivalent treatment results when compared to procedures performed under general anesthesia. METHODS For trajectories near a post of the Cosman-Roberts-Wells (CRW) frame (Integra LifeSciences, Plainsboro, New Jersey), we used preoperative MRI imaging to 3-dimensional-print a patient-specific mask with a trajectory guide to indicate the planned entry point during headframe placement. Otherwise, routine headframe placement and stereotactic registration were performed. Stereotactic biopsy and placement of the cranial bolt were performed in a standard neurosurgical operating room. The patient was transferred to a diagnostic MRI suite and positioned in the MRI scanner using beanbags and a custom molded thermoplastic mask. LITT was delivered with the patient conscious in the MRI scanner according to the manufacturer's recommendations. We collected patient demographics, treatment time, length of stay, and calculated preoperative tumor volume and postoperative ablation volumes. RESULTS Ten sequential patients were treated with LITT from January 2016 until March 2017. The average preoperative tumor volume was 6.9 cm3. The average tissue volume ablated was 18.3 cm3. The mean operative time was 31 min (standard deviation [SD] 10 min) and mean time with laser delivery in MRI was 79 min (SD 27 min). The mean length of stay was 1.4 d (SD 0.9). There were no major complications. CONCLUSION Using trajectory preplanning, customized face masks, and noninvasive head immobilization, LITT can be delivered to patients safely and accurately without general anesthesia.
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Affiliation(s)
- Dimitri Laurent
- Department of Neurosurgery, University of Florida, Gainesville, Florida
| | - Seth F Oliveria
- Department of Neurosurgery, University of Florida, Gainesville, Florida
| | - Michael Shang
- Department of Neurosurgery, University of Florida, Gainesville, Florida
| | - Frank Bova
- Department of Neurosurgery, University of Florida, Gainesville, Florida
| | - Rachel Freedman
- Department of Neurosurgery, University of Florida, Gainesville, Florida
| | - Maryam Rahman
- Department of Neurosurgery, University of Florida, Gainesville, Florida
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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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Wu D, Li G, Patel N, Yan J, Monfaredi R, Cleary K, Iordachita I. Remotely Actuated Needle Driving Device for MRI-Guided Percutaneous Interventions. ... INTERNATIONAL SYMPOSIUM ON MEDICAL ROBOTICS. INTERNATIONAL SYMPOSIUM ON MEDICAL ROBOTICS 2019; 2019:10.1109/ismr.2019.8710176. [PMID: 32864663 PMCID: PMC7451234 DOI: 10.1109/ismr.2019.8710176] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
In this paper we introduce a remotely actuated MRI-compatible needle driving device for pain injections in the lower back. This device is able to manipulate the needle inside the closed-bore MRI scanner under the control of the interventional radiologist inside both the scanner room and the console room. The device consists of a 2 degrees of freedom (DOF) needle driver and an actuation box. The 2-DOF needle driver is placed inside the scanner bore and driven by the actuation box settled at the end of the table through a beaded chain transmission. This novel remote actuation design could reduce the weight and profile of the needle driver that is mounted on the patient, as well as minimize the potential imaging noise introduced by the actuation electronics. The actuation box is designed to perform needle intervention in both manual and motorized fashion by utilizing a mode switch mechanism. A mechanical hard stop is also incorporated to improve the device's safety. The bench-top accuracy evaluation of the device demonstrated a small mean needle placement error (< 1 mm) in a phantom study.
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Affiliation(s)
- Di Wu
- Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, MD 21218, USA
- Department of Mechanical Engineering, Technical University of Munich, Garching 85748, Germany
| | - Gang Li
- Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Niravkumar Patel
- Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Jiawen Yan
- Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Reza Monfaredi
- Childrens National Medical Center, 111 Michigan Avenue, NW Washington, DC 20010
| | - Kevin Cleary
- Childrens National Medical Center, 111 Michigan Avenue, NW Washington, DC 20010
| | - Iulian Iordachita
- Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, MD 21218, USA
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Hansson Mild K, Lundström R, Wilén J. Non-Ionizing Radiation in Swedish Health Care-Exposure and Safety Aspects. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E1186. [PMID: 30987016 PMCID: PMC6479478 DOI: 10.3390/ijerph16071186] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 03/26/2019] [Accepted: 03/28/2019] [Indexed: 12/13/2022]
Abstract
The main aim of the study was to identify and describe methods using non-ionizing radiation (NIR) such as electromagnetic fields (EMF) and optical radiation in Swedish health care. By examining anticipated exposure levels and by identifying possible health hazards we also aimed to recognize knowledge gaps in the field. NIR is mainly used in health care for diagnosis and therapy. Three applications were identified where acute effects cannot be ruled out: magnetic resonance imaging (MRI), transcranial magnetic stimulation (TMS) and electrosurgery. When using optical radiation, such as class 3 and 4 lasers for therapy or surgical procedures and ultra-violet light for therapy, acute effects such as unintentional burns, photo reactions, erythema and effects on the eyes need to be avoided. There is a need for more knowledge regarding long-term effects of MRI as well as on the combination of different NIR exposures. Based on literature and after consulting staff we conclude that the health care professionals' knowledge about the risks and safety measures should be improved and that there is a need for clear, evidence-based information from reliable sources, and it should be obvious to the user which source to address.
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Affiliation(s)
- Kjell Hansson Mild
- Department of Radiation Sciences, Umeå University, S-90185 Umeå, Sweden.
| | - Ronnie Lundström
- Department of Radiation Sciences, Umeå University, S-90185 Umeå, Sweden.
| | - Jonna Wilén
- Department of Radiation Sciences, Umeå University, S-90185 Umeå, Sweden.
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Silva D, Sharma M, Barnett GH. Laser Ablation vs Open Resection for Deep-Seated Tumors: Evidence for Laser Ablation. Neurosurgery 2018; 63 Suppl 1:15-26. [PMID: 27399359 DOI: 10.1227/neu.0000000000001289] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Danilo Silva
- Department of Neurosurgery, Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - Mayur Sharma
- Department of Neurosurgery, Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - Gene H Barnett
- Department of Neurosurgery, Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
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Chen Y, Godage I, Su H, Song A, Yu H. Stereotactic Systems for MRI-Guided Neurosurgeries: A State-of-the-Art Review. Ann Biomed Eng 2018; 47:335-353. [PMID: 30377898 DOI: 10.1007/s10439-018-02158-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Accepted: 10/17/2018] [Indexed: 10/28/2022]
Abstract
Recent technological developments in magnetic resonance imaging (MRI) and stereotactic techniques have significantly improved surgical outcomes. Despite the advantages offered by the conventional MRI-guided stereotactic neurosurgery, the robotic-assisted stereotactic approach has potential to further improve the safety and accuracy of neurosurgeries. This review aims to provide an update on the potential and continued growth of the MRI-guided stereotactic neurosurgical techniques by describing the state of the art in MR conditional stereotactic devices including manual and robotic-assisted. The paper also presents a detailed overview of MRI-guided stereotactic devices, MR conditional actuators and encoders used in MR conditional robotic-assisted stereotactic devices. The review concludes with several research challenges and future perspectives, including actuator and sensor technique, MR image guidance, and robot design issues.
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Affiliation(s)
- Yue Chen
- Department of Mechanical Engineering, University of Arkansas, Fayetteville, AR, USA.
| | - Isuru Godage
- School of Computing, DePaul University, Chicago, IL, USA
| | - Hao Su
- Department of Mechanical Engineering, City College of New York, New York, NY, USA
| | - Aiguo Song
- School of Instrument Science and Engineering, Southeast University, Nanjing, People's Republic of China
| | - Hong Yu
- Department of Neurological Surgery, Vanderbilt University, Nashville, TN, USA
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Rennert RC, Khan U, Tatter SB, Field M, Toyota B, Fecci PE, Judy K, Mohammadi AM, Landazuri P, Sloan A, Leuthardt E, Chen CC. Patterns of Clinical Use of Stereotactic Laser Ablation: Analysis of a Multicenter Prospective Registry. World Neurosurg 2018; 116:e566-e570. [DOI: 10.1016/j.wneu.2018.05.039] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 05/04/2018] [Accepted: 05/05/2018] [Indexed: 11/30/2022]
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50
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Renfrow JJ, Strowd RE, Laxton AW, Tatter SB, Geer CP, Lesser GJ. Surgical Considerations in the Optimal Management of Patients with Malignant Brain Tumors. Curr Treat Options Oncol 2018; 18:46. [PMID: 28681208 DOI: 10.1007/s11864-017-0487-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OPINION STATEMENT Advances in technology are revolutionizing medicine and the limits of what we can offer to our patients. In neurosurgery, technology continues to reduce morbidity, increase surgical accuracy, facilitate tissue acquisition, and promote novel techniques for prolonging survival in patients with neuro-oncologic disease. Surgery has been the backbone of glioma diagnosis and treatment by providing adequate, high quality material for precise histologic diagnosis, and genomic characterization in the setting of significant intratumoral heterogeneity, thus allowing personalized treatment selection in the clinic. The ability to obtain and accurately measure the maximal extent of resection in glioma surgery also remains a central role of the neurosurgeon in managing this cancer. To meet these goals, today's operating room has transformed from the traditional operating table and anesthesia machine to include neuronavigation instrumentation, intraoperative computed tomography, and magnetic resonance imaging scanners, advanced surgical microscopes fitted with fluorescent light filters, and electrocorticography machines. While surgeons, oncologists, and radiation oncologists all play unique critical roles in the care of patients with malignant gliomas, familiarity with developing techniques in complimentary subspecialties can enhance coordination of patient care, research productivity, professional interactions, and patient confidence and comfort with the physician team. Herein, we provide a summary of the advances in the field of neurosurgical oncology which allow more precise and optimal surgical resection for patients with malignant gliomas.
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Affiliation(s)
- Jaclyn J Renfrow
- Department of Neurosurgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157-1082, USA.
| | - Roy E Strowd
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC, USA.,Department of Internal Medicine - Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Adrian W Laxton
- Department of Neurosurgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157-1082, USA
| | - Stephen B Tatter
- Department of Neurosurgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157-1082, USA
| | - Carol P Geer
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Glenn J Lesser
- Department of Internal Medicine - Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA
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