1 case of staging laser interstitial heat therapy (LITT) treatment of low-grade glioma in island leaf

Backgroundthe complex and important structure of nerve function around the island leaves and the vascular structure, so the complete removal of low-level gliomas of the island leaves can be challenging and may result in complications of functional impairments such as language, cognition, memory, emotion, and sensation (such as smell or taste)With minimal lynx, laser interstitial heat therapy (LITT) of the NeuroBlate system (laser interstitial thermal therapy) focuses on the tumor for precise ablation, protecting the normal tissue structure around the lesionThe NeuroBlate system has a 3mm diameter CO2frozen laser probe that acts on surrounding tissues from 1 to 2 cmEffective treatment has been obtained for some difficult-to-surgically accessible brain-level gliomas, metastatic tumors and epilepsyTumors with a diameter of 3cm can be treated in a single session, and the whole tumor needs to be ablifyed through multiple trajectories for lesions with a diameter of 3cmHowever, for larger tumors, the risk of surgical complications such as symptomatic edema and seizures is higherDaniel MHafez, of The College of Medicine at Washington University, and others used a new method of staging LITT to treat a large, small-sudden glioblastoma (WHO II) case in the leaf of the dominant hemispheric island, which was published online in May 2019 in Neurosurgerythe method of study
a 68-year-old female patient was treated for right-handed convulsions and mental symptomsThe head MRI prompts that the tumor with a maximum diameter of about 5cm on the left island leaf, and the language functional area shown by the functional MRI imaging is located around the tumor (Figure 1)Figure 1Functional MRI-T1 weighted crown bit (A) and shaft bit (B) see left island leaf tumor, surrounded by language function positioningfirst to carry out lesions biopsy, specimen pathology results for WHO level II less protoscoccal glioblastoma, 1p/19q total deletion and IDH1 mutation The patient did not agree to open cranial tumor removal surgery, after communication with the patient decided to carry out phased LITT tumor ablation Within 3 months, 2 stages of LITT treatment were performed on different areas of the tumor, and the location of the laser probe was verified before each ablation (Figure 2), which would maximize the coverage of the tumor with the threshold of laser heat, while avoiding the brain function area figure 2 Location image of the location of the laser probe during stage s (A and B) and PHASE II (C and D) LITT ablation therapy results I LITT treatment targeted at the second half of the tumor, after 1 week of follow-up, patients had minor word repetition difficulties, and stage II treatment had been restored to the original level 60 days after treatment, MRI showed that the tumor volume was reduced from 5.2 x 3.3 x 2.4cm to 3.6 x 1.9 x 1.4cm (Figure 3) Figure 3 MRI-FLAIR images showed that the left island leaf less protrusion glioblastoma was treated with staging LITT, and the tumor volume decreased significantly 2 years (J-L) 60 days after preoperative (A-C) to phase I ablation (D-F), phase II ablation ii phase ablation range, including the first half of the island leaf glioma and the front of the temporal lobe, avoiding the branches of the arteries in the brain After treatment, the patient developed mild aphasia and was treated with steroids for 2 weeks to alleviate the symptoms The patient recovered well after both treatments and continued to undergo chemotherapy During the follow-up 2 years, MRI imaging showed that the lesions were nearly subsiding (Figure 4) Figure 4 Tumor volume calculations are performed using the Stealth Station neuronavigation software A-C MRI coronal, axial, and bistoid images show the initial tumor volume (blue line: 40cm3) and post-stage LITT post-treatment tumor volume (powder line: 10cm3) ;D-F.MRI imaging shows the tumor volume (green line: 28cm3) and stage II post-treatment volume (orange line: 20cm3); During the 2-year follow-up, the residual volume remained stable for 18 months (red line: 5cm3) conclusions the case report showed that the treatment of slow-growing, larger island leaf low-level glioma stoicism with staging LITT can obtain good clinical prognosis, achieve similar effects as open cranial surgery, and reduce the degree of damage to normal tissue and nerve function in patients Phased laser ablation therapy can also be evaluated between two courses of treatment to adjust the treatment plan The authors believe that LITT can be used as a minimally invasive treatment for suitable patients and suggest further clinical trial studies.