Stereotactic cryoablation of large tumors of the sellar region with intraoperative CT scans\u2014technical note

Arun Angelo Patil

doi:10.1186/s41984-021-00105-1

Abstract

BackgroundCryoablation has been used by neurosurgeons in the past and is currently being used by other disciplines to treat kidney cancer, skin lesions, and cardiac conduction defects. Because the currently available cryogenic probes can safely create large lesions and the lesion generation (in the form of ice-ball) can be monitored on intraoperative CT images, cryoablation was used to treat large tumors in and around the sella. In this paper, the author describes a technique to perform this procedure.Main bodyThree large tumors in 3 patients were treated with this method. Age of the patients was 26–58 years with a male/female ratio of 2/1. Patient 1 had a non-secreting pituitary adenoma (measuring 8 × 8 cm) and presented with long-standing total visual loss in both eyes, severe headache, and seizures. She had previous resection and radiation therapy. Patient 2 had prolactinomas (measuring 5.1 × 4.6 cm) and presented with progressive loss of vision and diplopia. Patient 3 had recurrent craniopharyngioma (measuring 7.2 × 5 cm) with prior treatment with resection radiation and frequent drainage of the cyst. He presented with headache and progressive worsening of his vision.The procedure was done on the CT table with intraoperative scans, using Patil stereotactic frame and argon cryoablation probe (Healthtronics). 3-D images were used to plan targets and trajectories. The probe was placed at the target via a trans-nasal trans-sphenoidal route. One to 3 lesions measuring 2.5–3 cm in diameter were made to ablate the tumor. Ice-ball formation was monitored live on CT images.There is no complication. One patient had near-complete resolution of the tumor, two had partial resolution of their tumors, and all had resolution of their presenting symptoms at follow-up of 3–24 months (median 6 months). In one patient, symptoms reoccurred due to the formation of new tumor masses.Short conclusionCryoablation of intracranial tumors and can be done safely and effectively. Live monitoring of lesion generation using CT imaging is a major advantage of this technique.

Highlights

Materials and method Three patients were treated with this method over the last 3 years
Live monitoring of lesion generation using CT imaging is a major advantage of this technique
Opened decompression was discussed with the patient but he opted for cryoablation

Summary

Introduction

Materials and method Three patients were treated with this method over the last 3 years. Patient 1 had a nonsecreting pituitary adenoma (measuring 8 × 8 cm) (Fig. 2a, b) with long-standing total visual loss in both eyes and seizures She had previous resection and radiation therapy. Patient 3 had recurrent craniopharyngioma (measuring 7.2 × 5 cm) (Fig. 4a–d) Prior treatment at another facility included resection, radiation, and frequent drainage of the cyst. Patient 1 had a non-secreting pituitary adenoma (measuring 8 × 8 cm) and presented with long-standing total visual loss in both eyes, severe headache, and seizures Patient 3 had recurrent craniopharyngioma (measuring 7.2 × 5 cm) with prior treatment with resection radiation and frequent drainage of the cyst He presented with headache and progressive worsening of his vision. The current treatment options for these tumors include medical treatment with dopamine agonist, trans-sphenoidal and/or transcranial resection, frequent drainage of the cyst, intra-cavitary chemotherapy, and radiation therapy

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