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Laser interstitial thermal therapy for deep-seated perivascular brain tumors is not associated with distal ischemia

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Abstract

Purpose

Laser interstitial thermal therapy (LITT) is a minimally invasive cytoreductive treatment option for brain tumors with a risk of vascular injury from catheter placement or thermal energy. This may be of concern with deep-seated tumors that have surrounding end-artery perforators and critical microvasculature. The purpose of this study was to assess the risk of distal ischemia following LITT for deep-seated perivascular brain tumors.

Methods

A retrospective review of a multi-institution database was used to identify patients who underwent LITT between 2013 and 2022 for tumors located within the insula, thalamus, basal ganglia, and anterior perforated substance. Demographic, clinical and volumetric tumor characteristics were collected. The primary outcome was radiographic evidence of distal ischemia on post-ablation magnetic resonance imaging (MRI).

Results

61 LITT ablations for deep-seated perivascular brain tumors were performed. Of the tumors treated, 24 (39%) were low-grade gliomas, 32 (52%) were high-grade gliomas, and 5 (8%) were metastatic. The principal location included 31 (51%) insular, 14 (23%) thalamic, 13 (21%) basal ganglia, and 3 (5%) anterior perforated substance tumors. The average tumor size was 19.6 cm3 with a mean ablation volume of 11.1 cm3. The median extent of ablation was 92% (IQR 30%, 100%). Two patients developed symptomatic intracerebral hemorrhage after LITT. No patient had radiographic evidence of distal ischemia on post-operative diffusion weighted imaging.

Conclusion

We demonstrate that LITT for deep-seated perivascular brain tumors has minimal ischemic risks and is a feasible cytoreductive treatment option for otherwise difficult to access intracranial tumors.

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Data availability

The dataset utilized during this study is available from the corresponding author upon reasonable request.

Abbreviations

CSF:

Cerebral spinal fluid

KPS:

Karnofsky performance status

LITT:

Laser interstitial thermal therapy

MRI:

Magnetic resonance imaging

DWI:

Diffusion weighted imaging

OS:

Overall survival

PFS:

Progression free survival

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Neurosurgery, Henry Ford Health, 2799 West Grand Blvd, Detroit, MI, 48202, USA

    Jared C. Reese, Hassan A. Fadel, Jacob A. Pawloski, Sameah Haider, Adam M. Robin, Steven N. Kalkanis & Ian Y. Lee

  2. Wayne State University School of Medicine, Detroit, MI, USA

    Mariam Samir

  3. University of Miami, Miami, FL, USA

    Sameah Haider, Ricardo J. Komatar, Evan Luther, Alexis A. Morell & Mike E. Ivan

Authors
  1. Jared C. Reese
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  2. Hassan A. Fadel
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Contributions

Each author listed contributed to the study design. H.F., J.P., M.S. and S.H. each contributed to data collection, analysis, and draft revisions. R.K, E.L, A.M, M.I, A.R., S.K. and I.L provided commentary on the final manuscript.

Corresponding author

Correspondence to Jared C. Reese.

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Competing interests

The authors declare no competing interests.

Competing interest

The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

This retrospective study was approved by the institutional review board (MRI Volumetrics of Patients Treated with Laser Ablation, IRB #9176) with a waiver of patient consent prior to data collection and analysis.

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Reese, J.C., Fadel, H.A., Pawloski, J.A. et al. Laser interstitial thermal therapy for deep-seated perivascular brain tumors is not associated with distal ischemia. J Neurooncol 166, 265–272 (2024). https://doi.org/10.1007/s11060-023-04546-6

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  • DOI: https://doi.org/10.1007/s11060-023-04546-6

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