LITT (Laser Induced Interstitial Thermotherapy) of Benign and Malignant Gliomas in the OPEN MR (0.5 Tesla, GE Signa SP)

Abstract

Summary LITT (Laser induced interstitial thermotherapy) is established in the therapy of benign gliomas , not suitable for open surgery, for years (Grade I, II WHO). There are just a few centers world wide performing it as a routine procedure. In the treatment of malignant gliomas (Grade III, IV WHO) LITT is a new, mostly adjuvant method in single cases. In combination with simultaneous oral chemotherapy (temozolomide) patients with recurrent glioblastomas (WHO IV°), who had had open surgery and radiation, are treated in the OPEN MR in a clinical study at the Klinikum Krefeld. A conventional Nd:YAG-Laser (1064 nm) is used for LITT. Since 1997 an OPEN MR (GE Signa SP, 0.5 Tesla) is used. It provides the new option of frameless stereotaxy/image guided, dynamic neuronavigation to optimise and vary the target point. The whole procedure is monitored in the “online mode” (T 1 -subtraction-mode). The so called “colour coded temperature mapping” shows the irradiation of energy near real time (3 sec. delay) and helps to preserve eloquent regions. The LITT becomes an easily repeatabel “one-time-one-place-procedure” in this new setup. Case reports document the clinical and neuroradiological (MR) follow up in benign and malignant recurrent gliomas after LITT.