A stereotactic frame-based drill guide-aided setting for laser interstitial thermal therapy

Markus F Oertel,Oliver Bozinov,Lennart H Stieglitz

doi:10.1007/s00701-021-04869-1

Abstract

BackgroundMagnetic resonance imaging (MRI)-guided laser interstitial thermal therapy (MRIgLITT) was demonstrated to be a viable neurosurgical tool. Apart from its variety of indications, different operative and technical nuances exist. In the present report, for the first time, the use and ability of a traditional Riechert-Mundinger (RM) stereotactic system combined with a novel drill guide kit for MRIgLITT are described.MethodsA stereotactic frame-based setting was developed by combining an RM system with a drill guide kit and centering bone anchor screwing aid for application together with an MRIgLITT neuro-accessory kit and cooled laser applicator system. The apparatus was used for stereotactic biopsy and consecutive MRIgLITT with an intraoperative high-field MRI scanner in a brain tumor case.ResultsThe feasibility of an RM stereotactic apparatus and a drill guide kit for MRIgLITT was successfully assessed. Both stereotactic biopsy and subsequent MRIgLITT in a neurooncological patient could easily and safely be performed. No technical problems or complications were observed.ConclusionThe combination of a traditional RM stereotactic system, a new drill guide tool, and intraoperative high-field MRI provides neurosurgeons with the opportunity to reliably confirm the diagnosis by frame-based biopsy and allows for stable and accurate real-time MRIgLITT.

Highlights

Magnetic resonance imaging (MRI)-guided laser interstitial thermal therapy (MRIgLITT) is an inviting treatment option in neurosurgery
For the first time, a traditional Riechert-Mundinger (RM) stereotactic system [6] was implemented in combination with a novel drill guide kit for MRIgLITT
The targeting and insertion system (Figs. 2 and 3) consists of an RM stereotactic circular Computed tomography (CT)-adapted titanium or half-open MRI compatible ceramic base ring, a semicircular aiming bow, a fixed instrument holder, a localization set available for CT and MRI applications, and a target point simulator (Inomed Medizintechnik GmbH, Emmendingen, Germany) combined with a drill guide kit and bone anchor centering screwing aid (Inomed Medizintechnik GmbH, Emmendingen, Germany) along with a StealthStation®

Summary

Introduction

Magnetic resonance imaging (MRI)-guided laser interstitial thermal therapy (MRIgLITT) is an inviting treatment option in neurosurgery. 2 and 3) consists of an RM stereotactic circular CT-adapted titanium or half-open MRI compatible ceramic base ring, a semicircular aiming bow, a fixed instrument holder, a localization set available for CT and MRI applications, and a target point simulator (Inomed Medizintechnik GmbH, Emmendingen, Germany) combined with a drill guide kit and bone anchor centering screwing aid (Inomed Medizintechnik GmbH, Emmendingen, Germany) along with a StealthStation®. Intraoperative high-field MRI was performed using an 8-channel head coil (NORAS MRI products, Hoechberg, Germany) in a 3-T MRI machine (Magnetom® Skyra VD13; Siemens Healthcare GmbH, Erlangen, Germany) This enabled simultaneous imaging of the lesion, laser probe location, and thermometry for real-time monitoring of tissue ablation (Fig. 4 a and b). The patient was awakened from general anesthesia, extubated, and transferred to the neurosurgical intermediate care unit for postoperative monitoring

Discussion

Study limitations

Conclusion