期刊
NEUROSURGERY
卷 63, 期 1, 页码 21-28出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1227/01.NEU.0000311254.63848.72
关键词
brain metastasis; brain tumor; laser-induced thermal therapy; magnetic resonance imaging-guided thermal therapy; magnetic resonance thermal imaging; minimally invasive therapy
资金
- BioTex, Inc.
- National Institues of Health [2 R44 CA079282, 5 R44 AG019276, 2 R44 CA101573, 2 R44 CA96227]
OBJECTIVE: We report the initial results of a pilot clinical trial exploring file safety and feasibility of the first real-time magnetic resonance-guided laser-induced thermal therapy of treatment-resistant focal metastatic intracranial turners. METHODS: Patients with resistant metastatic intracranial tumors who had previously undergone chemotherapy, whole-brain radiation therapy, and radiosurgery and who were recused from surgery were eligible for this trial. Under local anesthesia, a Leksell stereotactic head frame was used to insert a water-cooled interstitial fiberoptic laser applicator inside the cranium. in the bore of a magnetic resonance imaging (MRI) scanner, laser energy was delivered to heat the tumor while continuous MRI was performed. A computer workstation extracted temperature-sensitive information to display images of laser heating and computed estimates of the thermal damage zone. Posttreatment MRI scans were used to confirm the zone of thermal necrosis, and follow-up was performed at 7, 15, 30, and 90 clays after treatment. RESULTS: In all cases, the procedure was well tolerated without secondary effect, and patients were discharged to home within 14 hours after the procedure. Follow-up imaging showed an acute increase in apparent lesion volume followed by a gradual and steady decrease. No tumor recurrence within thermal ablation zones was noted. CONCLUSION: In this ongoing trial, a total of four patients have had six metastatic tumors treated with laser thermal ablations. Magnetic resonance-guided laser-induced thermal therapy appears to provide a new, efficient treatment for recurrent focal metastatic brain disease. This therapy is a prelude to the future development of closed-head interventional MRI techniques in neurosurgery.
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