Endoscopic laser ablation of clival chordoma with magnetic resonance-guided laser induced thermal therapy

Background: Chordomas are rare malignant tumors that are difficult to treat and have high recurrence rates despite aggressive therapy. Objectives: We present the first case of a patient with a clival chordoma in which complete tumor ablation was achieved using Magnetic Resonance guided Laser Induced Thermal Therapy (LITT) delivered via an endoscopic endonasal approach. We analyzed the safety and feasibility of this approach and quantified the response of this pathology to thermal energy. This novel technique is intended to provide chordoma patients with an alternative to surgery and radiotherapy. Methods: A 54 year-old female with a newly diagnosed clival chordoma elected MRI- guided LITT. She underwent placement of the laser catheter into the chordoma via an endoscopic endonasal approach. With real-time MR thermometry monitoring, laser-generated thermal energy was delivered to the tumor. We defined several parameters to quantify the thermal ablation response: the thermal damage ratio and the thermal ablation constant. Results: Post procedure contrast-enhanced MRI demonstrated a complete thermal ablation of the mass. The patient tolerated the procedure well and is being followed with serial imaging. The tumor continues to regress beyond 4 months. Additionally, chordoma cells seem to be sensitive to LITT, as indicated by a complete ablation in less than 60 s. Conclusion: The endoscopic endonasal approach to MRI-guided laser ablation is both technically feasible and safe. As a result, this therapy may be a useful alternative in hard-to-reach chordomas, or in recurrent cases that have failed other conventional treatment modalities

Magnetic resonance-guided laser interstitial thermal therapy for posterior fossa neoplasms

PURPOSE: Magnetic resonance-guided laser interstitial thermal therapy (LITT) has been increasingly used to treat a number of intracranial pathologies, though its use in the posterior fossa has been limited to a few small series. We performed a multi-institutional review of targets in the posterior fossa, reporting the efficacy and safety profile associated with laser ablation in this region of the brain. METHODS: A retrospective review of patients undergoing LITT in the posterior fossa was performed from August 2010 to March 2020. Patient demographic information was collected alongside the operative parameters and patient outcomes. Reported outcomes included local control of the lesion, postoperative complications, hospital length of stay, and steroid requirements. RESULTS: 58 patients across four institutions underwent LITT in the posterior fossa for 60 tumors. The median pre-ablation tumor volume was 2.24 cm(3). 48 patients (50 tumors) were available for follow-up. An 84% (42/50) overall local control rate was achieved at 9.5 months median follow up. There were two procedural complications, including insertional hemorrhage and laser misplacement and 12/58 (21%) patients developed new neurological deficits. There was one procedure related death. The median length of hospital stay was 1 day, with 20.7% of patients requiring discharge to a rehabilitation facility. CONCLUSIONS: LITT is an effective approach for treating pathology in the posterior fossa. The average target size is smaller than what has been reported in the supratentorial space. Care must be taken to prevent injury to surrounding structures given the close proximity of critical structures in this region

Magnetic resonance-guided laser interstitial thermal therapy for posterior fossa neoplasms

Magnetic resonance-guided laser interstitial thermal therapy (LITT) has been increasingly used to treat a number of intracranial pathologies, though its use in the posterior fossa has been limited to a few small series. We performed a multi-institutional review of targets in the posterior fossa, reporting the efficacy and safety profile associated with laser ablation in this region of the brain. A retrospective review of patients undergoing LITT in the posterior fossa was performed from August 2010 to March 2020. Patient demographic information was collected alongside the operative parameters and patient outcomes. Reported outcomes included local control of the lesion, postoperative complications, hospital length of stay, and steroid requirements. 58 patients across four institutions underwent LITT in the posterior fossa for 60 tumors. The median pre-ablation tumor volume was 2.24 cm . 48 patients (50 tumors) were available for follow-up. An 84% (42/50) overall local control rate was achieved at 9.5 months median follow up. There were two procedural complications, including insertional hemorrhage and laser misplacement and 12/58 (21%) patients developed new neurological deficits. There was one procedure related death. The median length of hospital stay was 1 day, with 20.7% of patients requiring discharge to a rehabilitation facility. LITT is an effective approach for treating pathology in the posterior fossa. The average target size is smaller than what has been reported in the supratentorial space. Care must be taken to prevent injury to surrounding structures given the close proximity of critical structures in this region