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Recently, the team of Professor Jia Wang from the Department of Neurosurgery of Beijing Tiantan Hospital affiliated to Capital Medical University successfully implemented the first domestic “Magnetic Resonance-guided Laser Interstitial Thermal Therapy (LITT)” in China, bringing more benefits to patients with brain tumors.
Many choices.
Last year, two physicians, Patel and Kim, gave a complete introduction to LITT in the Missouri Medical Journal.
01What kind of brain tumor surgery is LITT? LITT is an emerging minimally invasive and cytoreductive neurosurgery technique, which is suitable for various central nervous system diseases from tumors to epileptic lesions, which is difficult to achieve with traditional surgery.
LITT is performed by implanting a laser catheter into the tumor and heating it to a high temperature enough to kill the tumor.
However, the use of LITT also depends on many factors, including the size, shape and location of the tumor.
For example, LITT is most effective for spherical tumors less than 3 cm in diameter.
02 Surgical procedure The typical LITT procedure will be evaluated before the operation.
The surgical team may include epilepsy specialists, neurosurgeons and neuropsychologists who will request and review all medical records and examinations, especially electroencephalograms.
Brain imaging and neuropsychological examination.
The doctor may also recommend further laboratory work and imaging tests to determine suitability for LITT.
When the patient falls asleep under anesthesia, the surgeon drills a small hole in the skull at the back of the head.
The surgeon uses MRI to guide and navigate the laser line to the source of the epileptic seizure in the human brain.
This allows surgeons to continuously monitor brain tissue temperature, ensuring that laser-induced damage effectively targets the tumor and is not restricted by the healthy tissue surrounding the tumor.
Once the wires are in place, heat will be used to destroy the area.
Then, the surgeon removes the wire and sutures the incision with one or two stitches.
All patients must undergo post-operative monitoring for at least 24 hours before being discharged from the hospital.
Most people can go home in a shorter time than after craniotomy and resume work and normal activities.
Since this technique only requires a small incision and a small hole to guide the laser fiber through, the treatment does not require craniotomy and is considered minimally invasive.
However, the entire surgical procedure usually lasts 3-4 hours; many of them are spent carefully positioning the laser fiber, and the laser treatment itself takes a few minutes.
LITT can also help patients who do not respond to stereotactic radiosurgery or have radionecrosis (death of tissue caused by radiotherapy).
In the United States, there are currently two LITT systems to choose from: the NeuroBlate® system (Monteris Medical, Winnipeg, Manitoba, Canada), which was approved by the FDA in 2009; and the Visualase® hyperthermia system (Visualase Inc.
, United States) Houston, Texas), was approved by the FDA in 2007.
A detailed description of these two systems has been reported before, and the basic biological mechanisms of action of the two systems are also very similar.
In the LITT ablation process, the photons emitted by the laser fiber are absorbed by the tumor cell chromophore, which causes the chromophore to be excited, and then releases heat energy.
Once a sufficiently high temperature is reached and maintained, protein denaturation, cell necrosis, and tissue coagulation occur.
The different wavelengths and other characteristics of these laser probe designs may result in different degrees of tissue penetration and ablation.
03 The main advantages of minimally invasive craniotomy.
This technology avoids the patient from performing craniotomy.
It only takes a small surgical incision to pass the probe through the scalp and skull into the designated area, and the surgical treatment time only takes a few minutes.
The scope of intracranial injury was significantly reduced.
At the same time, the slender optical fiber can reach the deep brain tissue that is not easy to be detected by craniotomy, so it is more suitable for patients with deep brain lesions.
When the precise lesion is located at the junction of gray and white matter, the technology uses intraoperative magnetic resonance to visually monitor the damage process, accurately distinguish the anatomical relationship between the lesion and the surrounding normal brain tissue, so as to more accurately damage the lesion; safely pass the intraoperative Real-time temperature monitoring, while damaging the lesion, fully protects the normal brain tissue around the lesion.
Studies have confirmed that LITT can better protect patients' high-level cognitive functions such as memory and language in the treatment of diseases such as temporal lobe epilepsy.
Studies have confirmed that deep brain metastases that are ineffective in stereotactic radiosurgery (SRS) treatment may be safe and effective.
In addition, LITT may also exert a synergistic effect with chemotherapy drugs by affecting the permeability of the blood-brain barrier.
The value of LITT in the treatment of certain pathologies, such as recurrent glioma and epileptic lesions, has been fully affirmed.
The data on the new use of LITT is very promising, and the indications for this operation are constantly increasing.
ReferenceHong, CS, Deng, D.
, Vera, A.
, & Chiang, VL (2019).
Laser-interstitial thermal therapy compared to craniotomy for treatment of radiation necrosis or recurrent tumor in brain metastases failing radiosurgery.
Journal of neuro-oncology, 142(2), 309–317.
Doi: 10.
1007/s11060-019-03097-zLeuthardt, EC, Duan, C.
, Kim, MJ, Campian, JL, Kim, AH, Miller-Thomas, MM, Shimony, JS, & Tran, DD (2016).
Hyperthermic Laser Ablation of Recurrent Glioblastoma Leads to Temporary Disruption of the Peritumoral Blood Brain Barrier.
PloS one, 11(2), e0148613.
Doi: 10.
1371/journal.
pone.
0148613Patel, B.
, & Kim , AH (2020).
Laser Interstitial Thermal Therapy.
Missouri medicine, 117(1), 50–55.
Many choices.
Last year, two physicians, Patel and Kim, gave a complete introduction to LITT in the Missouri Medical Journal.
01What kind of brain tumor surgery is LITT? LITT is an emerging minimally invasive and cytoreductive neurosurgery technique, which is suitable for various central nervous system diseases from tumors to epileptic lesions, which is difficult to achieve with traditional surgery.
LITT is performed by implanting a laser catheter into the tumor and heating it to a high temperature enough to kill the tumor.
However, the use of LITT also depends on many factors, including the size, shape and location of the tumor.
For example, LITT is most effective for spherical tumors less than 3 cm in diameter.
02 Surgical procedure The typical LITT procedure will be evaluated before the operation.
The surgical team may include epilepsy specialists, neurosurgeons and neuropsychologists who will request and review all medical records and examinations, especially electroencephalograms.
Brain imaging and neuropsychological examination.
The doctor may also recommend further laboratory work and imaging tests to determine suitability for LITT.
When the patient falls asleep under anesthesia, the surgeon drills a small hole in the skull at the back of the head.
The surgeon uses MRI to guide and navigate the laser line to the source of the epileptic seizure in the human brain.
This allows surgeons to continuously monitor brain tissue temperature, ensuring that laser-induced damage effectively targets the tumor and is not restricted by the healthy tissue surrounding the tumor.
Once the wires are in place, heat will be used to destroy the area.
Then, the surgeon removes the wire and sutures the incision with one or two stitches.
All patients must undergo post-operative monitoring for at least 24 hours before being discharged from the hospital.
Most people can go home in a shorter time than after craniotomy and resume work and normal activities.
Since this technique only requires a small incision and a small hole to guide the laser fiber through, the treatment does not require craniotomy and is considered minimally invasive.
However, the entire surgical procedure usually lasts 3-4 hours; many of them are spent carefully positioning the laser fiber, and the laser treatment itself takes a few minutes.
LITT can also help patients who do not respond to stereotactic radiosurgery or have radionecrosis (death of tissue caused by radiotherapy).
In the United States, there are currently two LITT systems to choose from: the NeuroBlate® system (Monteris Medical, Winnipeg, Manitoba, Canada), which was approved by the FDA in 2009; and the Visualase® hyperthermia system (Visualase Inc.
, United States) Houston, Texas), was approved by the FDA in 2007.
A detailed description of these two systems has been reported before, and the basic biological mechanisms of action of the two systems are also very similar.
In the LITT ablation process, the photons emitted by the laser fiber are absorbed by the tumor cell chromophore, which causes the chromophore to be excited, and then releases heat energy.
Once a sufficiently high temperature is reached and maintained, protein denaturation, cell necrosis, and tissue coagulation occur.
The different wavelengths and other characteristics of these laser probe designs may result in different degrees of tissue penetration and ablation.
03 The main advantages of minimally invasive craniotomy.
This technology avoids the patient from performing craniotomy.
It only takes a small surgical incision to pass the probe through the scalp and skull into the designated area, and the surgical treatment time only takes a few minutes.
The scope of intracranial injury was significantly reduced.
At the same time, the slender optical fiber can reach the deep brain tissue that is not easy to be detected by craniotomy, so it is more suitable for patients with deep brain lesions.
When the precise lesion is located at the junction of gray and white matter, the technology uses intraoperative magnetic resonance to visually monitor the damage process, accurately distinguish the anatomical relationship between the lesion and the surrounding normal brain tissue, so as to more accurately damage the lesion; safely pass the intraoperative Real-time temperature monitoring, while damaging the lesion, fully protects the normal brain tissue around the lesion.
Studies have confirmed that LITT can better protect patients' high-level cognitive functions such as memory and language in the treatment of diseases such as temporal lobe epilepsy.
Studies have confirmed that deep brain metastases that are ineffective in stereotactic radiosurgery (SRS) treatment may be safe and effective.
In addition, LITT may also exert a synergistic effect with chemotherapy drugs by affecting the permeability of the blood-brain barrier.
The value of LITT in the treatment of certain pathologies, such as recurrent glioma and epileptic lesions, has been fully affirmed.
The data on the new use of LITT is very promising, and the indications for this operation are constantly increasing.
ReferenceHong, CS, Deng, D.
, Vera, A.
, & Chiang, VL (2019).
Laser-interstitial thermal therapy compared to craniotomy for treatment of radiation necrosis or recurrent tumor in brain metastases failing radiosurgery.
Journal of neuro-oncology, 142(2), 309–317.
Doi: 10.
1007/s11060-019-03097-zLeuthardt, EC, Duan, C.
, Kim, MJ, Campian, JL, Kim, AH, Miller-Thomas, MM, Shimony, JS, & Tran, DD (2016).
Hyperthermic Laser Ablation of Recurrent Glioblastoma Leads to Temporary Disruption of the Peritumoral Blood Brain Barrier.
PloS one, 11(2), e0148613.
Doi: 10.
1371/journal.
pone.
0148613Patel, B.
, & Kim , AH (2020).
Laser Interstitial Thermal Therapy.
Missouri medicine, 117(1), 50–55.
