Laser Interstitial Therapy Research Articles

Abstract PO2-18-07: Ultrasound – guided Interstitial Laser therapy for Stage I Breast Cancer: a phase 2 trial

Abstract Background: Screening programs are changing the scope of breast cancer, with a growing number of patients diagnosed at a nearly stage. The current standard treatment (breast conservation and radiation therapy) offers an excellent prognosis for these patients. Besides tumor removal, other techniques can be used to destroy a mass in place. A range of minimally invasive techniques holds promise on local breast tumor ablation (i.e. thermotherapy, cryotherapy, and irreversible electroporation). Previous studies with Interstitial laser thermotherapy (ILT) for breast cancer report mean ablation rates between 33% to 87%. Most common cited causes for failure are equivocal tumor size estimation, inadequate technique and the learning curve. Objective: Improve the ILT technique and achieve better ablation rates through the evaluated procedure. Methods: A prospective study with 15 patients with Stage I invasive breast cancer, presented as a unique lesion as inclusion criteria was conducted. MRI and US were used to estimate the primary tumor volume and rule out multicentric/multifocal disease. ILT ablation was performed using an Echolaser unit (Elesta) through percutaneous laser optical fibers with a US-guided insertion in the lesion center. All procedures were performed under local anesthesia and sedation. The post procedure image reevaluation included an immediate US after the ablation and a new MRI about 3 hours after the procedure. The definitive proposed surgical treatment was carried out 8-13 days after the ILT ablation. Results: Eighteen patients were included in the study, of whom 14 (with 15 lesions) completed the protocol. The mean tumor size measured by MRI was 13.7 (4-20) mm. The mean treatment time was 10.1 minutes and all patients went home the same day, reporting only mild (78%) or moderate (22%) pain, controlled with analgesics. The mean ablation index, evaluated by H&E and CK8/18, was 61,5% (0 -93%) and when only tumors under 15 mm were considered the mean ablation index was 75% (30%-93%). The MRI performed after ablation procedure showed a large area of edema around the clip in all cases. The sensitivity and specificity to detect residual tumors were 1.0 and 0.84, respectively, when the residual tumors were larger than 15% of the original tumor size . Conclusions: These preliminary results suggest that laser therapy can eliminate viable neoplastic tissue in vivo. To achieve better results, standardization in patient selection, power and energy applied, should be considered. There are several advantages of ILT for breast cancer treatment, including preserving the structure and function of breast, no bleeding, no scaring and no radiation. More studies refining the technique should be conducted to allow the implementation of ILT as an alternative to surgical treatment in early breast cancer. Citation Format: Danielle Matsumoto, Silvio Bromberg, Marcus Corpa, Rodrigo Garcia, Guilherme Mariotti, Monica Rudner, Angela Waitzberg, Afonso Nazário, Gil Facina. Ultrasound – guided Interstitial Laser therapy for Stage I Breast Cancer: a phase 2 trial [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-18-07.

The role of neuromodulation in the management of drug-resistant epilepsy.

Drug-resistant epilepsy (DRE) poses significant challenges in terms of effective management and seizure control. Neuromodulation techniques have emerged as promising solutions for individuals who are unresponsive to pharmacological treatments, especially for those who are not good surgical candidates for surgical resection or laser interstitial therapy (LiTT). Currently, there are three neuromodulation techniques that are FDA-approved for the management of DRE. These include vagus nerve stimulation (VNS), deep brain stimulation (DBS), and responsive neurostimulation (RNS). Device selection, optimal time, and DBS and RNS target selection can also be challenging. In general, the number and localizability of the epileptic foci, alongside the comorbidities manifested by the patients, substantially influence the selection process. In the past, the general axiom was that DBS and VNS can be used for generalized and localized focal seizures, while RNS is typically reserved for patients with one or two highly localized epileptic foci, especially if they are in eloquent areas of the brain. Nowadays, with the advance in our understanding of thalamic involvement in DRE, RNS is also very effective for general non-focal epilepsy. In this review, we will discuss the underlying mechanisms of action, patient selection criteria, and the evidence supporting the use of each technique. Additionally, we explore emerging technologies and novel approaches in neuromodulation, such as closed-loop systems. Moreover, we examine the challenges and limitations associated with neuromodulation therapies, including adverse effects, complications, and the need for further long-term studies.This comprehensive review aims to provide valuable insights on present and future use of neuromodulation.

Functional outcomes in MRI-guided laser interstitial therapy for temporal lobe epilepsy: a systematic review and meta-analysis.

The use of MRI-guided laser interstitial thermal therapy (MRgLITT) has emerged as a promising treatment option for patients with drug-resistant temporal lobe epilepsy (TLE). Although the minimally invasive approach holds promise as an effective treatment for achieving seizure freedom, a comprehensive review of its impact on functional outcomes is still warranted. To address this need, this review aims to summarize data pertaining to the functional and neurocognitive outcomes following MRgLITT for TLE. Four primary electronic databases were screened following PRISMA guidelines by two independent reviewers. All functional data related to cognitive, behavioral, and emotional outcomes were gathered and analyzed as well as the neuropsychological tests issued to assess pre- and postoperative outcomes. The functional outcomes assessed were grouped into the 5 most common categories: verbal cognition, visual cognition, cognitive emotion, visual deficits, and other higher-order cognitive functioning. A total of 4184 studies were screened and ultimately 408 patients from 14 studies were included for analysis. Changes in functional areas were assessed by comparing pre- and postoperative scores across a comprehensive set of 31 different functional and cognitive assessments, and were tabulated as the percentage of patients whose status improved, declined, or was maintained, where possible. In verbal (n = 112) and visual (n = 42) cognition, the rates of patients experiencing a decline were 20.4% and 13.5%, respectively, and the rates of improvement were 24.9% and 16.7%, respectively. Other functional outcomes assessed, including cognitive emotion (n = 150), visual deficits (n = 325), and higher-order cognitive processes like attention/processing (n = 19), motor cognition (n = 18), and general executive function (n = 4), exhibited varying rates of decline, ranging from 10.5% to 25%. MRgLITT is an effective and minimally invasive surgical alternative treatment for TLE, but there is an observable impact on patient functioning and cognitive status. This review demonstrates the need for standardized methods that can accurately capture and quantify the associated risk of MRgLITT to optimize its effect on patient quality of life moving forward.

Real-life efficacy interstitial laser therapy treating laxity of the periorbital region

Skin laxity in the periorbital region is a common problem that is usually treated surgically. This is not only invasive, but it also increases the risks for the patient and can result in scarring. Innovative therapies involving the use of the most recent generation of interstitial lasers allow for safe, minimally invasive, and effective intervention in patients suffering from blepharochalasis and periorbital bags. A 100% Made in Italy intra-tissue laser lifting technology, in particular, delivers energy to the subcutaneous tissue via laser fibers as small as 200/300 microns, ensuring a targeted release of energy and allowing the formation of new collagen while decreasing skin laxity. The purpose of this study is to assess the effect of an interstitial laser using optical microfibers on 5 patients aged 30 to 60 years. Following anesthesia (Lidocaine and Adrenaline), the treatment was performed using an endotissue laser with a wavelength of 1470 nm. The cumulative energy delivered by the laser by using 300-micron disposable fibers is equal to 200 Joules for each lid, with an infrared thermometer confirming an increase in skin temperature not exceeding 40°C. Over the next six months, patients experienced optimal results with no visible skin signs. In conclusion, we can state that intra-tissue laser lifting can be an effective strategy for the treatment of periorbital laxity, resulting in a decrease in dermal laxity and greater skin homogeneity while ensuring high precision, the absence of superficial incisions, rapid recovery, and optimal results.

Transnasal targeted delivery of therapeutics in central nervous system diseases: a narrative review.

Currently, neurointervention, surgery, medication, and central nervous system (CNS) stimulation are the main treatments used in CNS diseases. These approaches are used to overcome the blood brain barrier (BBB), but they have limitations that necessitate the development of targeted delivery methods. Thus, recent research has focused on spatiotemporally direct and indirect targeted delivery methods because they decrease the effect on nontarget cells, thus minimizing side effects and increasing the patient's quality of life. Methods that enable therapeutics to be directly passed through the BBB to facilitate delivery to target cells include the use of nanomedicine (nanoparticles and extracellular vesicles), and magnetic field-mediated delivery. Nanoparticles are divided into organic, inorganic types depending on their outer shell composition. Extracellular vesicles consist of apoptotic bodies, microvesicles, and exosomes. Magnetic field-mediated delivery methods include magnetic field-mediated passive/actively-assisted navigation, magnetotactic bacteria, magnetic resonance navigation, and magnetic nanobots-in developmental chronological order of when they were developed. Indirect methods increase the BBB permeability, allowing therapeutics to reach the CNS, and include chemical delivery and mechanical delivery (focused ultrasound and LASER therapy). Chemical methods (chemical permeation enhancers) include mannitol, a prevalent BBB permeabilizer, and other chemicals-bradykinin and 1-O-pentylglycerol-to resolve the limitations of mannitol. Focused ultrasound is in either high intensity or low intensity. LASER therapies includes three types: laser interstitial therapy, photodynamic therapy, and photobiomodulation therapy. The combination of direct and indirect methods is not as common as their individual use but represents an area for further research in the field. This review aims to analyze the advantages and disadvantages of these methods, describe the combined use of direct and indirect deliveries, and provide the future prospects of each targeted delivery method. We conclude that the most promising method is the nose-to-CNS delivery of hybrid nanomedicine, multiple combination of organic, inorganic nanoparticles and exosomes, via magnetic resonance navigation following preconditioning treatment with photobiomodulation therapy or focused ultrasound in low intensity as a strategy for differentiating this review from others on targeted CNS delivery; however, additional studies are needed to demonstrate the application of this approach in more complex in vivo pathways.

An Initial Experience of Completion Hemispherotomy via Magnetic Resonance-Guided Laser Interstitial Therapy

Introduction: In carefully selected patients with medically refractory epilepsy, disconnective hemispherotomy can result in significant seizure freedom; however, incomplete disconnection can result in ongoing seizures and poses a significant challenge. Completion hemispherotomy provides an opportunity to finish the disconnection. We describe the use of magnetic resonance-guided laser interstitial thermal ablation (MRgLITT) for completion hemispherotomy. Methods: Patients treated with completion hemispherotomy using MRgLITT at our institution were identified. Procedural and seizure outcomes were evaluated retrospectively. Results: Five patients (3 males) underwent six MRgLITT procedures (one child treated twice) for completion hemispherotomy at a median age of 6 years (range 1.8–12.9). Two children had hemimegalencephaly, two had Rasmussen encephalitis, and one had polymicrogyria. All five children had persistent seizures likely secondary to incomplete disconnection after their functional hemispherotomy. The mean time from open hemispherotomy to MRgLITT was 569.5 ± 272.4 days (median 424, range 342–1,095). One patient underwent stereoelectroencephalography before MRgLITT. The mean number of ablation targets was 2.3 ± 0.47 (median 2, range 2–3). The mean length of the procedure was 373 min ± 68.9 (median 374, range 246–475). Four of the five patients were afforded improvement in their neurocognitive functioning and speech performance after ablation, with mean daily seizure frequency at 1 year of 1.03 ± 1.98 (median 0, range 0–5). Two patients achieved Engel Class I outcomes at 1 year after ablation, one was Engel Class III, and two were Engel Class IV. The mean follow-up time was 646.8 ± 179.5 days (median 634, range 384–918). No MRgLITT-related complications occurred. Delayed retreatment (>1 year) occurred in three patients: one child underwent redo ablation and two underwent anatomic hemispherectomy. Conclusion: We have demonstrated the feasibility of a minimally invasive approach for completion hemispherotomy using MRgLITT. Delayed retreatment was needed in three patients; thus, further study of this technique with comparison to other surgical techniques is warranted.

Clinical factors associated with late seizure remission after failed epilepsy surgery

BackgroundSome patients who initially fail epilepsy surgery later become seizure-free, but it is not clear how the clinical characteristics of the patients or post-operative modifications of anti-seizure medication (ASM) regimens contribute to late seizure remission. MethodsWe performed a retrospective chart review of patients undergoing epilepsy surgery at the University of Washington Regional Epilepsy Center between 2007 and 2017, including patients receiving neocortical resection, temporal lobectomy, and hippocampal laser interstitial therapy (LITT) ablation. We assessed seizure freedom, ASM changes, seizure frequency at the first and last follow-up, and type of lesion. Two-tailed Fisher’s exact test and Mann-Whitney U test were used for statistical analyses. ResultsTwo hundred and fifteen patients undergoing epilepsy surgery between 2007 and 2017 had both first and last follow-ups. Ninety-eight (46%) were not seizure-free at the first follow-up (mean 1.1 years post-operative). By the last follow-up (mean 4.7 years post-operative), 20% of those not initially seizure-free had become so. Those who were seizure-free at the last visit had lower median seizures per month in the first post-operative year (0.21 versus 0.95 per month in those not seizure-free, p < 0.001). There was also a significantly higher proportion of patients with cavernomas who were seizure-free at the last visit (25% vs. 1% of those not seizure-free at the last visit; p = 0.001), but no other differences in clinical characteristics. Of the 98 patients who had seizures at the first follow-up, 63% underwent post-operative modification of their ASM regimens. The rate of late seizure freedom was similar for patients with or without ASM changes: 21% were seizure-free at the last visit with ASM changes and 19% without ASM changes. There were no significant differences in which ASMs were changed between those who became seizure-free and those who did not, but patients who were subjected to further medical management were less likely to have had mesial temporal sclerosis (MTS) than those who were not. A number of patients not initially seizure-free who underwent ASM changes achieved seizure freedom as long as 10 years post-surgery. ConclusionA substantial proportion of patients who initially fail epilepsy surgery will have late seizure remission. Those with cavernous hemangiomas were more likely to achieve late remission from seizures as were those with lower rates of seizures in the first year after surgery. The chances of achieving remission were similar in those with or without modification of their ASM regimens, but those with pre-operative MTS were more likely to achieve late seizure freedom without medication changes. At the individual level, patients may still achieve seizure freedom with ASM changes as long as ten years after the initial surgery.

Magnetic Resonance Imaging–Guided Laser Interstitial Therapy for In-Field Recurrence After Stereotactic Radiosurgery: Is Complete Ablation Required for Local Control?

Magnetic resonance imaging-guided laser interstitial therapy (MrLITT) presents a new valuable treatment alternative when the in-field recurrence (IFR) of metastatic brain tumors is difficult to safely access with open surgery or maximum radiation therapy has already been completed. To examine the effects of MrLITT on longevity outcomes based on volume of ablation. A retrospective study was carried out of 35 patients treated with MrLITT for IFR after radiosurgery for metastatic brain tumors at a single institution from 2010 to 2016. Overall survival (OS) and progression-free survival (PFS) were analyzed with Kaplan-Meier and Cox regression analyses according to ablation volume. Univariate and multivariate analyses further assessed risk factors based on ablation volume. Kaplan-Meier analyses showed no significant differences between total and subtotal ablation groups in OS (61.1 vs. 49.7 weeks) and PFS (45.1 and 42.7 weeks), respectively (P > 0.05). In the subtotal ablation group, independent risk factors included preoperative tumor volume (hazard ratio [HR], 1.24; P= 0.05) for OS and residual tumor volume (HR, 2.62; P= 0.01) for PFS. Multivariate Cox regressions suggested no significant differences in OS (HR, 1.03; P= 0.19) and PFS (HR, 1.02; P= 0.24) between total and subtotal ablation groups, whereas preoperative tumor volume remained a risk factor for decreased OS (HR, 1.23; P= 0.004). MrLITT is an effective treatment option for IFR after radiosurgery for metastatic brain tumors. The benefits of more aggressive gross total ablations of deep targets near eloquent cortices are limited compared with effective subtotal ablations, but the amount of residual tumor volume left must be appropriately balanced.

Placental Giant Chorangioma: A Rare Case Report with Favorable Outcome

Chorangiomas are benign non trophoblastic vascular neoplasm arising from primitive chorionic mesenchyme. It isthe most frequent placental tumor occurring in 1% of pregnancies. Giant chorangioma(&gt;5 cms) exemplifies adversefetal and maternal outcomes. Chorangiomas need to be differentiated from chorangiosis, chorangiomatosis,inflammatory myofibroblastic tumor, leiomyomas, placental infarcts and chorangiocarcinomas. USG is thegold standard for diagnosis of chorangioma. Color Doppler is benificial in differentiation of chorangioma fromdegenerated uterine leiomyoma or associated other placental tumors. Therapeutic interventions of chorangiomais controversial like draining excessive amniotic fluid or surgical intervention like laser coagulation and interstitiallaser therapy. All placentas need to be examined histopathologically for confirmation of diagnosis and todifferentiate from other tumors.

Effectiveness of laser therapy for the treatment of lumbosacral radiculoischemias

Introduction.The study was devoted to assessing the effectiveness of laser therapy in the treatment of spondylogenic radiculoischemias. Low-intensity laser therapy and vaporization technology were used.Aim – to improve treatment and outcomes in patients with compression of the spinal roots in herniated intervertebral discs using various methods of laser therapy.Materials and methods. In two groups, the results of treatment of 225 patients with clinical manifestations of spondylogenic lumbosacral radiculoischemias were analyzed using laser therapy techniques. In 115 cases (group 1), laser treatment was performed using the method of puncture polychannel laser disk decompression. In 110 patients (group 2), low-intensity percutaneous laser therapy was used. The dynamics of the clinical and neurological manifestations of the disease was recorded: the time of pain syndrome reduction, the dynamics of motor and sensory disorders of the corresponding root, changes in parameters according to the Roland-Morris and Oswestry Disability questionnaire.Results. In both groups, an improvement in clinical and neurological manifestations was obtained: the intensity of pain syndrome according to VAS decreased in more than 70 % of the observed individuals. A significant improvement in the parameters of vital activity was revealed according to scales with a long-lasting effect (more than 12 months) with an improvement in the blood supply to the spinal roots.Conclusion. Laser radiation has significant clinical effectiveness; the important parameters are the wavelength and rate of the radiation. Structural-modifying action and improvement of microcirculation (of arterial and venous bed) are achieved. Evaluation of the effectiveness of polychannel laser puncture decompression is advisable using scales and questionnaires. Low-intensity percutaneous laser therapy and monochannel interstitial laser therapy provide a targeted antiedemic and neuroprotective effect with the possibility of dosing and control. The treatment is highly effective and improves the prognosis of the disease.

LGG-21. MR-GUIDED LASER INTERSTITIAL THERMAL THERAPY FOR UNRESECTABLE AND SYMPTOMATIC PEDIATRIC LOW GRADE GLIOMA

BACKGROUNDPediatric low-grade gliomas (LGG) not amenable to resection, while often indolent, represent a significant source of cancer-related morbidity and an unmet therapeutic need. Standardly, these patients are treated with sequential lines of chemotherapy, while delaying as long as possible radiation. Magnetic resonance-guided laser interstitial therapy (LITT) is a minimally invasive procedure that utilizes real-time MR thermography to ablate brain lesions.METHODSA 15-year-old girl was diagnosed with a suprasellar, hypothalamic LGG, BRAF V600E mutation positive. The tumor was unresectable, and due to progressive vision loss and headaches, the patient underwent treatment. Despite sequential trials of thioguanine/procarbazine/lomustine/vincristine, carboplatin/vincristine, dabrafenib, and combination dabrafenib/trametinib, the patient continued to experience debilitating headaches, malnutrition, school absenteeism, and overall poor quality-of-life. Using real-time, sequential MRI-thermometry and the Neuroblate cooled directional laser catheter, the bulk of the enhancing tumor was heated to a killing temperature.RESULTSAt 1-year post LITT, the patient’s symptoms were dramatically improved, including greatly improved headaches, malnutrition, school absenteeism, and overall quality of life. LITT was generally well tolerated, though the patient had slight progressive left homonymous hemianopia, thought secondary to LITT impact on the optic tracts. The tumor progressively shrank over the year post-LITT to a peak of 42% volume reduction.CONCLUSIONWe report a case of a pediatric patient with an unresectable low grade glioma who underwent LITT with excellent clinical and radiographic effects. LITT should be considered for children with unresectable and morbid LGGs that fail to respond to more conventional therapies.

Current trends in the management of subependymal giant cell astrocytomas in tuberous sclerosis.

The management of subependymal giant cells astrocytomas (SEGAs) has been traditionally represented by surgical treatment through an open craniotomic approach. Though open surgery still represents a major option in the management of this kind of tumors, the introduction of mTOR inhibitors in the clinical practice, technological advances in neuroendoscopy and the more recent use of laser interstitial therapy have significantly enlarged the range of available management opportunities. A thorough review of the literature has been performed. Accordingly, current views in open surgical treatment, medical therapy, endoscopic tumor removal and new trends (such as laser interstitial thermal therapy) are discussed. The risk of significant neurological morbidity (5-50%) complicating open surgery has been for a long time representing a main drawback in the management of SEGAs. More recent series report a significant reduction of morbidity and mortality. The mTOR inhibitors have demonstrated efficacy in both warranting a tumor reduction by up to 60% of the tumor size and helping the control of seizures. However, the reported rate of side effects is as high as 30% and tumor recurrence is a documented occurrence at the time of mTOR inhibitor discontinuation. Endoscopic tumor removal has been more extensively considered an option due to the acquisition of new tools. Limits are still represented by tumor size (< 3 cm) and broad attachment of the tumor to the basal ganglia. Laser interstitial thermal therapy (LITT)is the more recently considered option. Though promising, only short follow-up is available so far, while data on medium- and long-term results of this treatment are completely lacking to date. Surgical treatment remains a mainstay of the management of SEGAs. The indication for an open craniotomic approach should be balanced with an endoscopic tumor removal or LITT according to patient conditions, presence or not of an active hydrocephalus and extension of the attachment of the tumor to the basal ganglia. The mTOR inhibitors do have a definite role both as primary and as adjuvant treatment, but consistent limitations are represented up to now by a not negligible rate of complications and the uncertainties related to the possibility of tumor recurrence once the medical treatment is discontinued.

Stereotactic laser interstitial thermal therapy for brainstem cavernous malformations: two preliminary cases

Brainstem cavernous malformations (CMs) often have high hemorrhage rates and significant posthemorrhage morbidity. The authors present two cases in which magnetic resonance thermography-guided laser interstitial therapy was used for treatment of pontine CMs after recurrent hemorrhage. Both patients showed significant symptomatic improvement and were hemorrhage-free at 12- and 6-month follow-up, respectively. Each had radiographic evidence of lesion involution on serial follow-up imaging. These early results demonstrate this treatment modality may be technically safe; however, larger case numbers and longer follow-up are needed to demonstrate efficacy.

First-trimester intervention in twin reversed arterial perfusion sequence.

To report the outcome of monochorionic twins with twin reversed arterial perfusion (TRAP) sequence following interstitial laser therapy in the first trimester. This was a retrospective cohort study of all consecutive cases of TRAP that underwent interstitial laser therapy at ≤ 14 + 3 weeks' gestation between January 2014 and April 2016. Interstitial laser treatment was performed under ultrasound guidance using a 400-nm Nd:YAG laser fiber. Hospital records were reviewed to ascertain perinatal survival and morbidity. Twelve monochorionic twin pregnancies underwent interstitial laser treatment of the umbilical artery of the acardiac fetus, at a median gestational age of 13 + 5 (interquartile range (IQR), 13 + 4 to 14 + 0) weeks. In all cases, one treatment was sufficient to achieve complete interruption of the perfusion of the acardiac twin. There were no procedure-related complications during or within 48 h after the procedure. In one (8.3%) case, intrauterine death of the pump twin occurred 2 weeks after the intervention. All other cases (91.7%) resulted in a live birth at a median gestational age of 39 + 6 (IQR, 37 + 1 to 41 + 2) weeks and with a median birth weight of 3370 (IQR, 2980-3480) g. No neonatal mortality or serious morbidity occurred. Our results support the use of interstitial laser therapy in the first trimester of pregnancy complicated by TRAP sequence, showing a live birth rate of 92%. The results of a randomized controlled trial, evaluating early vs late intervention in pregnancy with TRAP sequence, are awaited. © 2019 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.

Outcome of Pregnancies Diagnosed with TRAP Sequence Prenatally: A Single-Centre Experience

Introduction: Twin reversed arterial perfusion (TRAP) sequence is a phenomenon seen in 1–3% of monochorionic twin pregnancies, where the acardiac fetus is found to have multiple anomalies. The normal pump twin maintains its own perfusion in addition to that of its acardiac co-twin. As a result, if the acardiac twin increases in size, the burden on the pump twin is increased, leading to cardiac failure, hydrops fetalis, polyhydramnios, premature delivery, and perinatal death. The outcome of pregnancy is largely dependent on the growth of the acardiac twin. In view of high perinatal loss, surgical techniques to interrupt the blood flow to the acardiac twin have been evaluated. Methods: We evaluated interstitial laser therapy, which is the main mode of therapy in our unit, of TRAP pregnancies referred over a 5-year period. Interstitial laser was offered if the blood flow in the acardiac twin was found to be persistent at 2 consecutive examinations or if there were cardiac or hydropic changes in the pump twin at the first examination. Results: A total of 18 cases of TRAP were referred during this period and all were counselled regarding fetal therapy if the situation were to deteriorate; 5 couples (27.7%) opted for termination of pregnancy; of the remaining 13, 7 (53.8%) agreed to perform intervention following confirmation of a normal karyotype. Six (85.7%) and 1 (14.3%) lasers were performed in the second and third trimesters, respectively; all 7 had a normal outcome of the pump twin. There were 6/13 (46.2%) in the expectant group who continued the pregnancy with no intervention, with 2 term live births (33.3%). Conclusions: Our study confirms that there is a high risk of spontaneous loss in untreated pregnancies with TRAP, primarily due to polyhydramnios and fetal hydrops. In the pregnancies that underwent interstitial laser, there was a more favourable outcome. Interstitial laser is minimally invasive, safe, and feasible in experienced hands.

How Intraoperative Tools and Techniques Have Changed the Approach to Brain Tumor Surgery.

Surgical treatment of brain tumors remains an integral part of a comprehensive treatment plan. Here, we review technological advances that have enhanced what surgeons are capable of doing within and outside the traditional operating room. Extent of surgical resection has improved with the use of MRI and fluorescent dyes intraoperatively. Neurological injury during brain tumor surgery has decreased with appropriate use of neurophysiological monitoring. New operative scopes have enhanced ability of surgeons to visualize tissues during dissection. Laser interstitial therapy and radiation treatment have made possible the treatment of previously considered non-operable brain tumors in addition to replacing or serving as adjunct to surgical treatment of brain tumors. Surgery remains an important pillar in treatment of most brain tumors. Ongoing technological advances have augmented extent of what is possible in this realm.

Ablation energies for focal treatment of prostate cancer

ContextIn recent years, focal therapy has emerged as a treatment option for a selected group of men with localized prostate cancer. Cryotherapy and high-intensity focused ultrasound (HIFU) are the most investigated types of focal treatment with other options currently under evaluation.ObjectiveThe objective of the study was to give a comprehensive overview of six available focal treatment options for prostate cancer with their rationale, delivery mechanism, and outcomes.Information acquisitionThe SIU ICUD chapter on available Energies to Treat Prostate Cancer was used as a guide to describe the different technologies. For outcomes, a literature search was conducted using PubMed key words including focal therapy, HIFU, cryotherapy, irreversible electroporation, vascular-targeted photodynamic therapy, laser interstitial therapy, radiofrequency ablation, microwave therapy, and their synonyms in MeSH terms.ConclusionFocal therapy appears to have encouraging outcomes on quality of life and urinary and erectile function. For oncological outcomes, it is challenging to fully interpret the outcomes due to heterogeneity in patient selection and short-term follow-up.

Laser-Induced Thermal Therapy in Neuro-Oncology: A Review.

Laser therapy has become an appealing treatment modality in neurosurgery. In this review, we report on the history, physics, surgical steps, indications and uses, and complications that have been reported to date. An extensive literature search was performed for laser interstitial thermal therapy (LITT) and laser therapy in the context of glial tumors, metastatic lesions, pediatric brain tumors, and radiation necrosis. Reported complications in each series also were reviewed. In the past decade, multiple studies have demonstrated the use, outcomes, and complications associated with LITT in neurosurgery. These same studies have consistently reported an overall benefit of LITT in cases in which traditional surgical approaches may be limited by the patient's clinical status, tumor location, or overall prognosis. However, there have been complications reported from local effects of thermal damage, technical error, and edema development. Increased experience has reduced complications and brought more promising results. With the advent of real-time monitoring and damage estimation, LITT has gained ground in the management of intracranial tumors. Larger scale trials must be performed to develop standard protocols to define specific indications for use. Further large clinical studies for LITT in non-oncologic cases are also of interest.

Laser interstitial thermal therapy for the treatment of epilepsy: evidence to date.

Medically intractable epilepsy is associated with increased morbidity and mortality. For those with focal epilepsy and correlated electrophysiological or radiographic features, open surgical resection can achieve high rates of seizure control, but can be associated with neurologic deficits and cognitive effects. Recent innovations have allowed for more minimally invasive methods of surgical seizure control such as magnetic resonance-guided laser interstitial therapy (MRgLITT). MRgLITT achieves the goal of ablating seizure foci while preserving neuropsycho-logical function and offering real-time feedback and monitoring of tissue ablation. This review summarizes the utilization of MRgLITT for mesial temporal lobe epilepsy and other seizure disorders. Overall, the efficacy of MRgLITT is comparable to that of open surgery and offers a less invasive approach in patients with significantly less morbidity.

Endoscopic Ho laser interstitial therapy for pharyngolaryngeal venous malformations in adults.

Many methods have been used to treat venous malformations, including sclerotherapy, laser therapy, and surgery. Nowadays, endoscopic laser surgery has become a popular therapeutic modality for most of pharyngolaryngeal venous malformations. There are various kinds of lasers that have been applied, but Holmium:YAG laser (Ho laser) has not been reported yet. Ho laser is produced by a kind of iraser which is made of yttrium aluminum garnet mixed with holmium, chromium and thulium. Aim of the current work is to evaluate the efficacy and safety of Ho laser interstitial therapy in pharyngolaryngeal venous malformations in adults. The clinical data of 42 patients with pharyngolaryngeal venous malformation treated with endoscopic Ho laser interstitial therapy over a 12-year period were retrospectively reviewed and analyzed. The wave length of Ho laser was 2.1µm and the diameter of optical fiber was 550µm. The pulse energy was 0.5J and the time of duration was 600µs. The highest output power was 100W. Outcomes were graded as cure (complete resolution), considerable reduction (>60-80% reduction), and no obvious change (<50% reduction). The lesions were well controlled without severe complications. Complete resolution of the lesion was observed in 95.1% of the patients, while 4.9% patients showed considerable reduction of the swelling. Complications occurred in 4.8% of patients. No respiratory troubles or other severe complications occurred. Endoscopic Ho laser interstitial therapy is an effective and safe treatment modality for pharyngolaryngeal venous malformations in adults.