The efficacy of laser interstitial thermal therapy in the management of spinal metastases: a systematic review of the literature

Laser interstitial thermal therapy for recurrent brain metastases following stereotactic radiosurgery: a systematic review

INTRODUCTION

Laser Interstitial Thermal Therapy (LITT) has emerged as a promising minimally invasive treatment option for recurrent brain metastases, especially for patients who have previously undergone Stereotactic Radiosurgery (SRS). Despite its growing use, additional research is needed to explore its utility and safety in this population.

METHODS

This systematic review evaluates the literature on LITT for recurrent brain metastases post-SRS, including patient selection, treatment protocols, outcomes, and complications. The review was registered with PROSPERO (CRD42024577899) and followed the PRISMA 2020 guidelines.

RESULTS

Seventeen studies, encompassing 694 patients, met our inclusion criteria. The median overall survival (OS) across these studies was 14.4 months with an average 12-month OS of 60.1%. Notably, median OS was 5.9 months after LITT alone and 12.7 months when LITT was followed by adjuvant SRS. The pooled local control rate was 75.6% at 6 months and 72.2% at 12 months.

CONCLUSION

LITT is a minimally invasive treatment option that has shown potential in managing recurrent brain metastases after prior SRS, particularly when biopsy is required to differentiate between tumor recurrence and radiation necrosis. However, data on the comparative efficacy and cost-effectiveness of LITT versus alternative treatments such as repeat SRS or craniotomy remain limited.

Complications following laser interstitial thermal therapy: a review

Laser interstitial thermal therapy (LITT) is being performed more frequently for various lesions within neurosurgery, including epileptic foci, vascular malformations, and tumors. Though this technique generally has an excellent safety profile, it is important to be aware of potential complications. Thermal ablation of tissue leads to disruption of the blood brain barrier as well as an inflammatory response both of which cause the majority of complications from LITT. The most common complications of LITT include cerebral edema, focal neurologic deficits, and intracranial hemorrhage. Few studies have identified factors predicting development of these complications, but many of these are transient and resolve without intervention. Modifications to LITT technique that allows better visualization of patient anatomy along the tract, such as fusing vascular imaging with intraoperative MRI, reduce the risk of complications.

IgA multiple myeloma-associated mediastinal spinal plasmacytoma presenting as spinal cord compression

Multiple myeloma associated with extramedullary plasmacytoma at initial presentation is rare. We describe a case of a man in his 30s who initially presented with symptoms of spinal cord compression. Further imaging revealed a mediastinal tumour, with a biopsy confirming plasmacytoma. Immunofixation revealed IgA lambda paraprotein. Bone marrow biopsy demonstrated atypical T-cell cytotoxic proliferation and trilineage hypoplasia. The patient was diagnosed with extramedullary plasmacytoma with active IgA multiple myeloma. The patient received mediastinal radiation to the tumour, followed by anti-myeloma therapy. This diagnosis is critical as managing a solitary plasmacytoma drastically differs from an extramedullary plasmacytoma with active multiple myeloma.

CT-guided percutaneous microwave ablation combined with bone cement injection for the treatment of transverse metastases: A case report

Metastatic diseases of the spine are becoming increasingly common with an aging population and improvements in systemic cancer therapies. Microwave and vertebroplasty are the mainstay modalities for treating painful spine metastases. Most early spinal metastases predominantly attack the adnexa, but there are few reports on its treatment. This report presents a case of a 56-year-old female who had experienced severe thoracic back pain for several days and was diagnosed with a metastatic tumor of the right transverse process of T7. Percutaneous microwave ablation in combination with bone cement injection was used to treat the metastatic tumor under CT guidance. The postoperative pain on the Visual Analogue Scale was 1/10, without nerve or vessel damage and bone cement leakage during the operation.

Laser Interstitial Thermal Therapy for the Treatment of a Pineal Region Glioma Through an Infratentorial Approach: A Case Report

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.