Technological Adjuncts for Malignant Brain Tumor Surgery-Andrew E. Sloan, MD, FAANS Video

Video Transcription

Video Summary

In this video, Dr. Andrew Sloan from University Hospitals of Cleveland in the Seidman Cancer Center discusses laser interstitial thermotherapy (LIT) for gliomas. LIT is a minimally invasive technique used for tumor ablation. However, the lack of precise and non-invasive monitoring and control of thermal energy delivery has limited its widespread adoption. LIT has several advantages including its minimally invasive nature, ability to reach difficult-to-access tumors, feasibility in patients with relative contraindications for surgery, and potential for combination with other therapies. It is crucial to maintain the temperature between 43 and 55 degrees centigrade to induce apoptosis, necrosis, and melt lipid bilayers that damage the tumor. Going above 57 degrees can cause coagulation, vaporization, and carbonization, leading to undesirable complications. The use of heat to treat tumors has a long history with various modalities like radiofrequency, radioactive energy, ultrasound, and cryotherapy. Recent advances include cooled probes, non-invasive real-time thermography, and prediction of thermal damage thresholds. Two commercially available platforms for LIT are the visualized platform and the Monteros platform. Studies have demonstrated increased survival rates and successful treatment of GBMs using LIT, especially for smaller lesions. Challenges with the literature on LIT include primarily retrospective studies, differences in treatment parameters and outcomes, and a lack of standardized indications and techniques. Future directions include improving software, incorporating DTI for fiber tracking, developing easier-to-use coils, and studying the combination of LIT with other treatments. Overall, LIT shows promise in the treatment of gliomas, brain metastases, and radiation necrosis, particularly for lesions under 10 cubic centimeters.

Keywords

laser interstitial thermotherapy

gliomas

minimally invasive technique

tumor ablation

temperature control