Issue link: https://viewer.e-digitaledition.com/i/748338
An Option for 'Inoperable' Brain Tumors Laser Interstitial Thermotherapy (LITT) with 'Mini' Craniotomy: A N E W PA P E R i n t he O c t ob er i s s ue of t he jou r n a l Neurosurgical Focus f inds the use of laser benef icia l for the remova l of la rge, "inoperable" gliobla stoma (GBM) a nd other t y pes of bra in tumors. The paper is authored by A ndrew Sloa n, MD, a nd his colleag ues from University Hospita ls Cleveland Medica l Center, Case Western Reserve Universit y School of Medicine a nd Case Comprehensive Ca ncer Center. Dr. Sloa n a nd others at the Case Comprehensive Ca ncer Center led the f irst in huma n tria ls, published in 2013, of a procedure with laser interstitia l thermotherapy (LITT), a minima lly inva sive approach using a la ser to "cook " a tumor through a tiny hole in the sca lp a nd bone a nd the intra-operative MR I (iMR I) to f ine tune the treatment rather tha n the surgeon's direct vision. While LITT was successful for brain tumors sma ller than the size of a golf ba ll, larger tumors often swelled following LITT, sometimes threatening the life of the patient. However, during a n operation to remove the swelling, Dr. Sloa n made a surprising f inding. The cooked tumor, rather tha n being tense a nd bloody a s he ex pected, wa s sof t, a nd its blood supply had been clotted off. This gave him the idea that he could treat even the la rger inoperable tumors sa fely w it h LITT if he combined it w it h a ver y sma ll cra niotomy which would a llow him to "suck out " the cooked tumor to prevent swelling. The Neurosurgical Focus paper describes this treatment on 10 patients who had dif f icu lt-to-access ma lig na nt tumors. The tumors had a media n volume of 38 cc. Eight patients had GBMs including " butterf ly GBMs," one had previously treated GBM, a nd one had a mela noma bra in meta sta sis. GBM is t he dead liest of bra in t umors a nd patients with them have a ver y poor prog nosis. Since the study, six patients rema in a live a nd four have died. "This procedure is a new option for patients with these la rge ma ligna nt tumors," says Dr. Sloa n. " We have seen simila r results a nd overa ll sur viva l compa red to LITT procedures performed in patients with smaller lesions and with lower risk." He feels that, with fur ther studies, LITT will continue to develop into a sa fer, more user-friendly technique that may help remove more of these deadly tumors than surger y a lone ca n accomplish. Dr. Sloa n directs the Bra in Tumor a nd Neuro-Oncolog y Center at U H Clevela nd Medica l Center a nd holds the Peter D. Crista l Cha ir of Neurosurg ica l Oncolog y a nd is Vice Cha ir of the Depa r tment of Neurolog ica l Surger y at U H a nd Ca se Comprehensive Ca ncer Center. He is a lso Professor of Neurosurger y at Case Western Reser ve Universit y School of Medicine. Other authors on the study are James Wright, MD, Jessey Chugh, MD, Christina Wright, MD, Jeffrey Sunshine, MD, Ferna ndo A lonso, MD, A lia Hdeib, MD, Ha ley Gittlema n, a nd Ji l l Ba r n holt z-Sloa n , Ph D, Un iversit y Hospit a ls C l e v e l a n d Me d i c a l C e nt e r, C a s e We s t e r n R e s e r v e Universit y School of Medicine a nd Case Comprehensive Ca ncer Center. Dr. Sloa n's work on this study a lso wa s suppor ted by t he Peter D. Cr ista l Cha ir of Neurosurg ica l Oncolog y a nd the Kimble Fa mily Foundation to the Depa r tment of Neurosurger y at UH Clevela nd Medica l Center. For more infor mation about t he st udy, v isit ht tp:// thejns.org/doi/full/10.3171/2016.8.FOCUS16233. A video abstract can also be found at https://vimeo.com/182386724. ■ 2 0 2 0❱❱❱❱❱ R E C E N T R E S E A R C H