| 书目名称 | Laser Interstitial Thermal Therapy in Neurosurgery | | 编辑 | Veronica L. Chiang,Shabbar F. Danish,Robert E. Gro | | 视频video | http://file.papertrans.cn/582/581524/581524.mp4 | | 概述 | The first text devoted to the use of LITT for treatment of intracranial pathologies..Written by experts in their specific neurosurgical subspecialties..Addresses cost-effectiveness and future directio | | 图书封面 |  | | 描述 | This book serves as a foundation for MRI guided laser interstitial thermal therapy (LITT) across neurosurgical diseases. It provides state-of-the-art information on the latest indications and results for LITT in CNS applications, as well as prerequisite historical perspective and technical fundamentals. Written by experts in the field, the text reviews the historical development of LITT, the technical and technological components required to perform LITT, its indications and contraindications, areas that still require investigation, LITT complications, and challenges to starting up LITT within one’s practice. As early adopters of the technology, the authors provide sage advice that reflects the initial learning curves of many of the users. The book then concludes with a practical guide to starting up a LITT practice in the current medical socioeconomic environment. .Laser Interstitial Thermal Therapy in Neurosurgery. is a guide that willallow all neurosurgeons interested in LITT to successfully adopt the technology and incorporate its use seamlessly, safely and appropriately into their individual practices.. | | 出版日期 | Book 2020 | | 关键词 | - Laser Fundamentals; Visualase; LITT; Metastatic In-Field Recurrence; LITT for Gliomas; Metastatic Tum | | 版次 | 1 | | doi | https://doi.org/10.1007/978-3-030-48047-9 | | isbn_softcover | 978-3-030-48049-3 | | isbn_ebook | 978-3-030-48047-9 | | copyright | Springer Nature Switzerland AG 2020 |
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Front Matter |
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Abstract
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,Magnetic Resonance-Guided Laser Interstitial Thermal Therapy: Historical Perspectives and Overview |
Richard Tyc,Mark G. Torchia,Kevin Beccaria,Michael Canney,Alexandre Carpentier |
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Abstract
Over the past 5 years, laser interstitial thermal therapy (LITT) has become a well-recognized and viable addition to the armamentarium of neurosurgeons when considering patient options for brain tumors and epilepsy. In addition, patients are actively seeking such alternative minimally invasive techniques when the prospect of open craniotomy is presented to them. As such, it is important that the fundamentals of LITT are well documented for both physicians and patients. This chapter provides a historical perspective of laser interstitial thermal therapy (LITT), including the fundamental science and contributing technologies including laser, laser-tissue interactions, imaging and thermal dosimetry, cellular effects of LITT and their relation to MR image appearance post-LITT, and clinical applications in brain lesions. The second half of the chapter is devoted to a description that compares and contrasts the two existing commercially available LITT systems, namely NeuroBlate. and Visualase.. In addition, included in this unique perspective are detailed approaches to clinical implementation, trajectory guidance, laser energy delivery probes, user interface and software systems, process
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,Technical Considerations for LITT: Getting Through the Procedure, |
Nitesh V. Patel,Simon Hanft,Veronica L. Chiang,David D. Gonda,Joseph S. Neimat,Shabbar F. Danish |
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Abstract
Laser ablation has become an integral tool within the neurosurgeon’s armamentarium. Applicability to a wide range of pathologies, while maintaining a minimally invasive profile, has been a key driving factor for laser ablation’s success. It has become increasingly utilized in the management of epilepsy and intracranial tumors. Two major laser ablation systems are commercially available at the present time. Neurosurgeons around the world utilize various stereotactic systems for laser insertion. However, the general principles guiding this procedure remain similar. This chapter should serve as a step-by-step how-to guide for operators. Our hope is that neurosurgeons can use this as a manual in their own practice for performing this operation.
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,Special Technical Considerations: LITT in the Awake Patient and the Pacemaker Patient, |
Brian D. Toyota,Jamie Joseph Van Gompel,Sanjeet S. Grewal |
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Abstract
Laser interstitial thermotherapy (LITT) or MR-guided laser ablation can be safely performed under local anesthetic in an awake patient as well as in a patient with a cardiac pacemaker. LITT in the awake patient is discussed with consideration of the advantages, techniques, and nuances of the process. The special situation of MR-based therapy for a patient harboring a cardiac pacemaker is also described.
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,Complications of LITT, |
Michael Schulder,Nick Kleiner |
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Abstract
Laser interstitial thermal therapy is a relatively new minimally invasive technique that allows for immediate delivery of treatment to an indicated lesion. While ablation of lesions without a craniotomy may be appealing, LITT carries its own set of risks and complications. Here, we illustrate three cases that feature the most commonly reported LITT-associated complications – misplacement of the laser fiber, hematoma from laser insertion, and hyperthermic injury. Morbidities from LITT complications ranged from transient aphasia to intracerebral/ventricular hemorrhage. There is evidence that the use of a stereotactic frame and intraoperative MRI throughout the procedure may prevent the incidence of complications; however, no large series examining complication rate of various techniques has been conducted. When performed with the necessary attention to technical and clinical detail, LITT is a safe, minimally invasive procedure that can be an effective alternative to open surgery.
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,LITT for Metastatic In-Field Recurrence, |
Nanthiya Sujijantarat,Shabbar F. Danish,Veronica L. Chiang |
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Abstract
Laser interstitial thermal therapy (LITT) offers a minimally invasive approach to the treatment of both regrowth of brain metastases and/or radiation necrosis following radiosurgery (known together as metastatic in-field recurrence). Current indications for LITT include patients who have KPS >70, have good expected survival or systemic therapy options, and are deemed suitable surgical candidates. While LITT treatment was previously offered when patients required initiation of steroids for symptom management, LITT results have been shown to be better when the lesion is smaller and therefore there is a current trend toward using LITT earlier in the course of the progression of these lesions. While surgical access is less invasive, adverse neurological outcomes following LITT are similar to those encountered in a craniotomy..Post-LITT imaging changes can be variable but generally follow a trend of an initial increase in the size of contrast-enhanced volume followed by a steady decrease over the subsequent 3–6 months. Surprisingly, FLAIR volumes often do not increase but rather can decrease rapidly in some cases and is often associated with the ability to wean steroids. With regard to
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,LITT Treatment of High-Grade Gliomas, |
Daria Krivosheya,Gene H. Barnett,Alireza M. Mohammadi |
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Abstract
Glioma is the most common primary malignancy of the brain and is associated with poor outcome, especially for high-grade tumors. Despite the diffuse nature of the disease typically warranting more comprehensive loco-regional treatment modalities such as radiation and systemic chemotherapy, focal treatments like surgery have been shown to have benefit in improving survival by reduction of tumor burden. Aggressive surgery, however, is not feasible in all locations, especially for deep-seated and difficult-to-access tumors, and minimally invasive treatment modalities such as laser ablation could be considered as an alternative to craniotomy for these tumors that traditionally would be candidates for biopsy alone. In this chapter, we review the literature regarding the clinical evidence of safety and efficacy of laser ablation as part of a multidisciplinary approach to glioma. Several studies will be reviewed including the most recent propensity-matched multicenter glioblastoma (GBM) study that showed that maximum ablation of newly diagnosed GBM improves disease-specific overall and progression-free survival compared with patients undergoing biopsy only. In addition to the cytoreductiv
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,LITT for Pediatric Brain Tumors, |
George W. Koutsouras,Monserrat Almaguer Ascencio,Zulma Tovar-Spinoza |
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Abstract
Brain tumors are known to be the leading cause of cancer-related deaths in the pediatric population. Surgical resection of brain tumors may result in a permanent cognitive deficit or some other lasting neurological dysfunction. Chemotherapy has multiple side effects and radiation therapy includes the risk of radiation-induced brain damage or secondary brain tumors. MRI-guided LITT is an evolving and successful alternative form of therapy. Pilocytic astrocytomas, ependymomas, medulloblastomas, subependymal giant cell astrocytomas, and hypothalamic hamartomas are the most commonly studied forms of brain tumors seen to be treated with promising results with MRIgLITT. The technique has been associated with limited complications and a short hospital length of stay and could be considered as initial or adjuvant therapy with several advantages for the pediatric population.
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,LITT in the Treatment of Adult Epilepsy, |
Bartosz T. Grobelny,Jon T. Willie,Robert E. Gross |
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Abstract
Magnetic resonance-guided laser interstitial thermal therapy (MRg-LITT) is becoming an increasingly used and more thoroughly understood method for real-time monitored thermal lesioning of tissue. It has found a particular niche in the treatment of medically refractory focal epilepsy for which it provides a less invasive alternative to craniotomy and resection for multiple pathologies such as mesial temporal lobe sclerosis, focal cortical dysplasia, cavernous malformations, hypothalamic hamartoma, and epileptogenic tumors. Stereotactic laser brain ablation is also an alternative to craniotomy for cortical resections in non-lesional epilepsy as well as to disconnection surgery as in corpus callosotomy. Clinical investigations have focused on understanding the advantages as well as limitations of using MRg-LITT in epilepsy surgery, especially for mesial temporal sclerosis (MTS), which has been the most studied etiology. Though laser ablation for MTS shows a good safety and efficacy profile compared to open surgery, the minimally invasive nature of this technique is also an attractive and promising method both for practitioners and patients for surgical treatment of multiple etiologies
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,LITT in Adult Functional Neurosurgery: Movement Disorders, |
Meghan Harris,Jessica Anne Wilden |
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Abstract
LITT for movement disorders like Parkinson’s disease and essential tremor is a new field largely consisting of case reports and case series to date. We describe the rationale for the development of this methodology and outline general patient selection criteria. We provide a four-part description of the general procedure itself, which is performed in a converted diagnostic MRI suite using the ClearPoint stereotactic system (MRI Interventions, Irvine, CA) and the Visualase laser ablation platform (Medtronic Inc., Louisville, CO). Technical modifications and early results are discussed separately for thalamotomy and pallidotomy at the end of the chapter.
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,LITT for Intractable Psychiatric Disease, |
Wael F. Asaad,Nicole C. R. McLaughlin |
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Abstract
Functional lesions for the treatment of intractable, debilitating psychiatric disease have been created using a variety of techniques over many decades. Here, we describe the relative advantages and disadvantages of laser thermal lesions and the application of this technique to one particular disease, refractory and severe obsessive-compulsive disorder (OCD). Early experience suggests this approach will enable the creation of reliable and morphologically consistent lesions while avoiding some of the pitfalls and complications of other lesion modalities.
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,LITT in Pediatric Epilepsy, |
Sara Hartnett,Daniel J. Curry |
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Abstract
MRgLITT was first used for treatment of epilepsy in a child in 2010. Since that initial case, the technique has been applied to many pediatric epileptogenic targets such as tuberous sclerosis, mesial temporal lobe epilepsy, focal cortical dysplasia, periventricular nodular heterotopia, insular epilepsy, cavernous malformation, and, most efficiently, hypothalamic hamartoma. The combination of instant thermal ablation and peri-operative steroids to combat edema has resulted in an 83% 1-year seizure freedom rate with 1.5% rate of memory impairment, making it a profound improvement on open surgery. The technique has also been applied in disconnection, such as in corpus callosotomy, both in de novo and in salvage cases. In the treatment of drop attacks, three to four lasers can be employed to achieve the disconnection minimally invasively, obviating the need for a craniotomy. Outside of hypothalamic hamartoma, there have been few large pathology-based series, and long-term cognitive data is not available. MRgLITT in pediatric epilepsy holds the promise of less morbidity and shorter hospital stays, steps that may narrow the treatment gap in pediatric epilepsy surgery from anxiety and mor
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,LITT for Spine Tumors, |
Rafael A. Vega,Dhiego C. A. Bastos,Claudio E. Tatsui |
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Abstract
Spine laser interstitial thermal therapy (sLITT) is a novel minimally invasive therapeutic modality for the treatment of metastatic epidural spinal cord tumors. When used in conjunction with spinal stereotactic radiosurgery (SSRS), it can provide effective and durable local control with minimal morbidity. This approach is ideally suited for patients who are poor candidates for larger-scale oncologic spinal surgery and can act synergistically with SSRS to maximize local control and palliate pain..Compared to other percutaneous techniques, sLITT is unique in offering real-time monitoring of thermal injury with use of an intraoperative MRI. As an alternative to conventional open surgery, its percutaneous nature is associated with a shortened hospital stays, minimal post procedure pain, and minimal blood loss. Furthermore, vascular tumors do not require preoperative embolization, patients with significant medical comorbidities usually tolerate the procedure well, and individuals in need of continued systemic therapy can safely be treated without interruption in chemotherapy. The technology is still early in its development, and similar to open surgery, it is not a stand-alone therapy b
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,Building a LITT Practice, |
Stephen B. Tatter,Adrian W. Laxton,Daniel E. Couture |
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Abstract
MRI thermometry-guided laser thermocoagulation (LITT) ablates pathologic tissue in the brain via a narrow approach corridor allowing otherwise surgically inaccessible targets to be reliably ablated with real-time feedback and allowing intracranial ablation to be performed with minimal invasiveness even for more accessible targets. This technique is a tour de force of neurosurgical technology requiring the coordination of institution-wide resources for success including the operating suite, anesthesiology, radiology, pathology, and inpatient and outpatient services. The return on this investment is high: in addition to profound surgical benefits for select patients, LITT offers shorter lengths of hospital stay, increased patient comfort and satisfaction, and decreased patient and caregiver stress. Making LITT available to those who can benefit from it requires coordinating diverse resources to build a successful practice..This chapter focuses on the technical decisions that the LITT team must make to accomplish this with respect to anesthesia; head fixation, stereotactic trajectory determination, implementation, and confirmation; laser fixation to the skull; obtaining tissue specime
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Back Matter |
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