Stereotactic Guided Laser-Induced Interstitial Thermotherapy (SLITT) in Gliomas with Intraoperative Morphologic Monitoring in an Open MR-Unit

M. Leonardi; C. Lumenta; H. Gumprecht; H. v Einsiedel; T. Wilhelm; null K

doi:10.1055/s-2001-13581

min - Minimally Invasive Neurosurgery, Inhaltsverzeichnis

Minim Invasive Neurosurg 2001; 44(1): 37-42
DOI: 10.1055/s-2001-13581

ORIGINAL PAPER

Georg Thieme Verlag Stuttgart · New York

Stereotactic Guided Laser-Induced Interstitial Thermotherapy (SLITT) in Gliomas with Intraoperative Morphologic Monitoring in an Open MR-Unit

M. A. Leonardi¹ , C. B. Lumenta¹ , H. K. Gumprecht¹ , H. v. Einsiedel² , T. Wilhelm²

¹Department of Neurosurgery, Academic Hospital München-Bogenhausen, Germany
²Institute for Diagnostic Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Germany

Abstract

Stereotactic guided laser-induced interstitial thermotherapy (SLITT) represents a minimal invasive method to produce necrosis in cerebral tumor tissue by local heating. The dose/response relationship relies on experimental studies and few clinical data performed in high field MR systems. A better understanding of the energy-dose/tissue response in human brain tumors is important to optimize this treatment modality. Twenty-four patients with gliomas were treated with SLITT, with a total of 30 laser procedures performed. Under local anesthesia 600 μm laser-fibers were inserted by stereotactic-guided technique into the center of the tumor. In a low field open MR system (0.2 T) the denaturation of the tumor using a neodymium YAG laser (1064 nm) was monitored by 3D-turbo FLASH T₁-weighted sequences. Laser energy was applied in steps of 400 to 1200 Joules. Development of necrosis at a mean total energy dose of 2979 Joules could be monitored in all procedures. Two different thermal lesion architectures were observed. First signal changes were monitored after a mean of 1108 Joules and 1393 Joules, respectively. Mean max. total lesion size was 21.2 mm. The higher the total energy the larger was the thermolesion, but no linear relationship could be seen. Tumor tissue response showed no dependency on tumor grading. Monitoring of stereotactic guided laser-induced thermolesions in the low-power MR OPEN is feasible and safe. Although lesion size basically is energy dependent, it should be applied individually, since the thermal response in brain tumors varies due to different optical properties, even in the same tumor gradings.

Key words:

Stereotactic - Open MRI - Laser - Interstitial thermotherapy

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Corresponding Author

M A LeonardiM.D.

Department of Neurosurgery
Städtisches Krankenhaus München-Bogenhausen

Englschalkinger Str. 77
81925 Munich
Germany

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