SURG-03. FUNCTIONAL OUTCOMES OF LASER INTERSTITIAL THERMAL THERAPY (LITT) VERSUS RESECTION IN THE TREATMENT OF LESIONS IN OR NEAR THE PRIMARY MOTOR CORTEX

2021 ◽  
Vol 23 (Supplement_6) ◽  
pp. vi195-vi195
Author(s):  
Ethan Srinivasan ◽  
Emily Lerner ◽  
Ryan Edwards ◽  
David Huie ◽  
Peter Fecci
Keyword(s):  
Motor Cortex ◽  
Functional Outcomes ◽  
Primary Motor Cortex ◽  
Thermal Therapy ◽  
Invasive Treatment ◽  
Motor Mapping ◽  
Laser Interstitial Thermal Therapy ◽  
Hospital Stays ◽  
The Difference ◽  
Pre Treatment

Abstract INTRODUCTION Laser interstitial thermal therapy (LITT) is a minimally-invasive treatment option for radiographically-progressive (RP) brain metastases. This study compares the functional outcomes of LITT vs resection (RS) for lesions in or near the primary motor cortex (PMC). METHODS Retrospective review was performed of patients treated for PMC lesions by LITT or RS. Functional outcomes were graded relative to pre-treatment symptoms and categorized as improved, stable, or worsened at 30, 90, and 180 days post-LITT/RS. RESULTS 36 patients were identified with median follow-up of 194 days (IQR 72-503), age 64 years (57-72), and estimated baseline KPS 80 (80-90). 35 (98%) had pre-treatment weakness or motor seizure; 15 (42%) received LITT and 21 (58%) RS; all RS were performed with intra-operative motor mapping while LITT were not. All LITT patients were treated for RP lesions (radiation necrosis (RN) or disease progression) vs. 24% of RS patients (p< 0.01). LITT patients trended towards smaller lesions (1.9 cm vs 2.7 cm, p=0.03) and were more likely to show RN (67% vs 5%, p< 0.01) and be discharged home (87% vs 52%, p=0.04), with shorter ICU (0 vs 1 day, p< 0.01) and hospital stays (1 vs. 2 days, p< 0.01). At 30 days, 89% of surviving patients who received RS had stable or improved symptoms, compared to 46% of the LITT cohort (p=0.02). At 90 days, the difference was 88% to 50% (p=0.07), and at 180 days 100% to 80% (p=0.2941). CONCLUSIONS In the short term (30 days), patients with PMC lesions have better functional outcomes when treated with RS compared to LITT, while those who survive to the 180-day timepoint experience similar outcomes. These differences are likely due to transient, expected post-LITT edema that subsides with time. Taken together, prognosis and patient priorities are important considerations in the decision between LITT and RS.

scholarly journals SURG-08. Laser Interstitial Thermal Therapy (LITT) versus Resection in the Treatment of Lesions In or Near the Primary Motor Cortex

2021 ◽  
Vol 3 (Supplement_3) ◽  
pp. iii25-iii25
Author(s):  
Ethan Srinivasan ◽  
Emily Lerner ◽  
Ryan Edwards ◽  
David Huie ◽  
Peter Fecci
Keyword(s):  
Motor Cortex ◽  
Functional Outcomes ◽  
Primary Motor Cortex ◽  
Thermal Therapy ◽  
Invasive Treatment ◽  
Motor Mapping ◽  
Laser Interstitial Thermal Therapy ◽  
Hospital Stays ◽  
The Difference ◽  
Pre Treatment

Abstract Introduction Laser interstitial thermal therapy (LITT) is a minimally-invasive treatment option for radiographically-progressive (RP) brain metastases. This study compares the functional outcomes of LITT vs resection (RS) for lesions in or near the primary motor cortex (PMC). Methods Retrospective review was performed of patients treated for PMC lesions by LITT or RS. Functional outcomes were graded relative to pre-treatment symptoms and categorized as improved, stable, or worsened at 30, 90, and 180 days post-LITT/RS. Results 36 patients were identified with median follow-up of 194 days (IQR 72–503), age 64 years (57–72), and estimated baseline KPS 80 (80–90). 35 (98%) had pre-treatment weakness or motor seizure; 15 (42%) received LITT and 21 (58%) RS; all RS were performed with intra-operative motor mapping while LITT were not. All LITT patients were treated for RP lesions (radiation necrosis (RN) or disease progression) vs. 24% of RS patients (p<0.01). LITT patients trended towards smaller lesions (1.9 cm vs 2.7 cm, p=0.03) and were more likely to show RN (67% vs 5%, p<0.01) and be discharged home (87% vs 52%, p=0.04), with shorter ICU (0 vs 1 day, p<0.01) and hospital stays (1 vs. 2 days, p<0.01). At 30 days, 89% of surviving patients who received RS had stable or improved symptoms, compared to 46% of the LITT cohort (p=0.02). At 90 days, the difference was 88% to 50% (p=0.07), and at 180 days 100% to 80% (p=0.2941). Conclusion In the short term (30 days), patients with PMC lesions have better functional outcomes when treated with RS compared to LITT, while those who survive to the 180-day timepoint experience similar outcomes. These differences are likely due to transient, expected post-LITT edema that subsides with time. Taken together, prognosis and patient priorities are important considerations in the decision between LITT and RS.

scholarly journals Neurosurgical applications of MRI guided laser interstitial thermal therapy (LITT)

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Usama Salem ◽  
Vinodh A. Kumar ◽  
John E. Madewell ◽  
Donald F. Schomer ◽  
Dhiego Chaves de Almeida Bastos ◽  
...  
Keyword(s):  
Treatment Options ◽  
Thermal Therapy ◽  
Invasive Technique ◽  
Laser Device ◽  
Invasive Treatment ◽  
Laser Interstitial Thermal Therapy ◽  
Alternative Treatment Option ◽  
Selective Ablation ◽  
Potential Applications ◽  
Mri Guided

Abstract MRI-guided laser interstitial thermal therapy (LITT) is the selective ablation of a lesion or a tissue using heat emitted from a laser device. LITT is considered a less invasive technique compared to open surgery that provides a nonsurgical solution for patients who cannot tolerate surgery. Although laser ablation has been used to treat brain lesions for decades, recent advances in MRI have improved lesion targeting and enabled real-time accurate monitoring of the thermal ablation process. These advances have led to a plethora of research involving the technique, safety, and potential applications of LITT. LITT is a minimally invasive treatment modality that shows promising results and is associated with decreased morbidity. It has various applications, such as treatment of glioma, brain metastases, radiation necrosis, and epilepsy. It can provide a safer alternative treatment option for patients in whom the lesion is not accessible by surgery, who are not surgical candidates, or in whom other standard treatment options have failed. Our aim is to review the current literature on LITT and provide a descriptive review of the technique, imaging findings, and clinical applications for neurosurgery.

Mapping From Motor Cortex to Biceps and Triceps Altered By Elbow Angle

2004 ◽  
Vol 92 (1) ◽  
pp. 395-407 ◽  
Author(s):  
Michael S. A. Graziano ◽  
Kaushal T. Patel ◽  
Charlotte S. R. Taylor
Keyword(s):  
Motor Cortex ◽  
Opposite Effect ◽  
Primary Motor Cortex ◽  
Joint Angle ◽  
Normal Function ◽  
Ventral Part ◽  
The Difference ◽  
Evoked Activity ◽  
Cortical Map ◽  
Intermediate Effect

This experiment used cortical microstimulation to probe the mapping from primary motor cortex to the biceps and triceps muscles of the arm in monkeys. The mapping appeared to change depending on the angle at which the elbow was fixed. For sites in the dorsal part of the arm and hand representation, the effects of stimulation were consistent with initiating a movement of the elbow to an extended angle. Stimulation evoked more triceps activity than biceps activity, and this difference was largest when the elbow was fixed in a flexed angle. For sites in the ventral part of the arm and hand representation, stimulation had the opposite effect, consistent with initiating a movement of the elbow to a flexed angle. For these sites, stimulation evoked more biceps activity than triceps activity, and the difference was largest when the elbow was fixed in an extended angle. For sites located in intermediate positions, stimulation evoked an intermediate effect consistent with initiating a movement of the elbow to a middle, partially flexed angle. For these sites, when the elbow was fixed at a flexed angle, the evoked activity was largest in the triceps, and when the elbow was fixed at an extended angle, the evoked activity was largest in the biceps. These effects were obtained with 400-ms-long trains of biphasic pulses presented at 200 Hz and 30 μA. They were also obtained by averaging the effects of individual, 30-μA pulses presented at 15 Hz. How this stimulation-evoked topography relates to the normal function of motor cortex is not yet clear. One hypothesis is that these results reflect a cortical map of desired joint angle.

scholarly journals SURG-07. Plasmonic gold nanostars to increase the efficiency and specificity of laser interstitial thermal therapy (LITT) in the treatment of brain tumors

2021 ◽  
Vol 3 (Supplement_3) ◽  
pp. iii24-iii25
Author(s):  
Ethan Srinivasan ◽  
Pakawat Chongsathidkiet ◽  
Ren Odion ◽  
Yang Liu ◽  
Eric Sankey ◽  
...  
Keyword(s):  
Ex Vivo ◽  
Thermal Therapy ◽  
Surrounding Tissue ◽  
Intracranial Tumors ◽  
Invasive Treatment ◽  
Laser Interstitial Thermal Therapy ◽  
Gold Nanostars ◽  
Pet Ct ◽  
The Impact

Abstract Introduction Laser interstitial thermal therapy (LITT) is an effective minimally-invasive treatment option for intracranial tumors. Our group produced plasmonics-active gold nanostars (GNS) designed to preferentially accumulate within intracranial tumors and amplify the ablative capacity of LITT while better conforming to tumor boundaries and protecting surrounding tissue. Materials and Methods: The 12nm GNS were synthesized using reduced HAuCl4 with Na3C6H5O7 seeds, mixed with AgNO3, C6H8O6, and HAuCL4, and coated with polyethylene glycol then functionalized with methoxy PEG thiol. CT-2A glioma cells were intracranially implanted into mice, followed 18 days later by IV injection of GNS. PET-CT was performed at 10-minutes, 24-, and 72-hours post-GNS administration, with autoradiography (AR) and histopathology (HP) on sacrifice after the last scan. To test the impact of GNS on LITT coverage capacity in appropriately sized ex vivo models, we utilized agarose gel-based phantoms incorporating control and GNS-infused central “tumors” in multiple shapes. LITT was administered with the NeuroBlate System. Results In vivo, GNS preferentially accumulated within intracranial tumors on PET-CT at the 24- and 72-hour timepoints. AR and HP confirmed high GNS accumulation within tumor. Ex vivo, in cuboid tumor phantoms, the GNS-infused phantom heated 5.5x faster than the control, rising 0.49°C per minute compared to 0.09°C. In a split-cylinder tumor phantom with half containing GNS, the GNS-infused border heated 2x faster and the surrounding area was exposed to 30% lower temperatures. In a GNS-infused star-shaped phantom, the heat spread contoured along phantom boundaries. Conclusion Our results provide evidence for use of GNS to improve the specificity, efficiency, and potentially safety of LITT. The in vivo data support selective accumulation within intracranial tumors, and the GNS-infused phantom experiments demonstrate increased rates of heating within the tumor model, heat contouring to tumor borders, and decreased heating of surrounding regions representing normal structures.

Gross Total Resection of a Grade IV Astrocytoma Adjacent to the Precentral Gyrus With Nonawake Motor Mapping and Motor-Evoked Potential Monitoring: 3-Dimensional Operative Video

2019 ◽  
Author(s):  
Burak Ozaydin ◽  
Ihsan Dogan ◽  
Bryan J Wheeler ◽  
Mustafa K Baskaya
Keyword(s):  
Motor Cortex ◽  
Evoked Potential ◽  
Primary Motor Cortex ◽  
Motor Evoked Potential ◽  
Gross Total Resection ◽  
Precentral Gyrus ◽  
Total Resection ◽  
Motor Mapping ◽  
3 Dimensional ◽  
Intraoperative Adjuncts

Abstract Surgical treatment of the gliomas located in or adjacent to the eloquent areas poses significant challenge to neurosurgeons. The main goal of the surgery is to achieve maximal safe resection while preserving the neurological function. This might be possible with utilizing pre- and intraoperative adjuncts such as functional magnetic resonance imaging (MRI), image guidance, mapping of the function of interest, intraoperative MRI, and neurophysiological monitoring. In this video, we demonstrate the utilization of nonawake mapping and motor-evoked potential (MEP) monitoring for the resection of a right-sided posterior superior frontal gyrus grade IV astrocytoma adjacent to the primary motor cortex. The patient is a 69-yr-old woman presented with multiple episodes of simple partial seizures involving her left leg and spreading to the left arm. MRI and functional MRI examinations showed a heterogeneously enhancing mass with peritumoral edema adjacent to the primary motor cortex. Because the patient did not want to undergo an awake craniotomy, a decision was made to perform the resection of the tumor with nonawake motor mapping and continuous MEP monitoring. Nonawake motor mapping and MEP monitoring enabled us to perform gross total resection. Because it has been shown that supratotal resection may provide improved survival outcome,1,2 we extended the white matter resection beyond the contrast enhancing area in noneloquent parts of the tumor. Surgical steps in dealing with vascular anatomy as well as utilizing intraoperative adjuncts such as motor mapping and MEP monitoring to enhance the extent of resection while preserving the function are demonstrated in this 3-dimensional surgical video.  The patient consented to publication of her operative video.

EXTH-19. INTEGRATION OF PLASMONIC GOLD NANOSTARS AND LASER INTERSTITIAL THERMAL THERAPY (LITT) FOR SPECIFIC AND AMPLIFIED ABLATION OF BRAIN TUMORS

2021 ◽  
Vol 23 (Supplement_6) ◽  
pp. vi167-vi167
Author(s):  
Ethan Srinivasan ◽  
Pakawat Chongsathidkiet ◽  
Ren Odion ◽  
Yang Liu ◽  
Eric Sankey ◽  
...  
Keyword(s):  
Ex Vivo ◽  
Thermal Therapy ◽  
Surrounding Tissue ◽  
Intracranial Tumors ◽  
Invasive Treatment ◽  
Laser Interstitial Thermal Therapy ◽  
Gold Nanostars ◽  
Pet Ct ◽  
The Impact

Abstract INTRODUCTION Laser interstitial thermal therapy (LITT) is an effective minimally-invasive treatment option for intracranial tumors. Our group produced plasmonics-active gold nanostars (GNS) designed to preferentially accumulate within intracranial tumors and amplify the ablative capacity of LITT while better conforming to tumor boundaries and protecting surrounding tissue. MATERIALS AND METHODS The 12nm GNS were synthesized using reduced HAuCl4 with Na3C6H5O7 seeds, mixed with AgNO3, C6H8O6, and HAuCL4, and coated with polyethylene glycol then functionalized with methoxy PEG thiol. CT-2A glioma cells were intracranially implanted into mice, followed 18 days later by IV injection of GNS. PET-CT was performed at 10-minutes, 24-, and 72-hours post-GNS administration, with autoradiography (AR) and histopathology (HP) on sacrifice after the last scan. To test the impact of GNS on LITT coverage capacity in appropriately sized ex vivo models, we utilized agarose gel-based phantoms incorporating control and GNS-infused central “tumors” in multiple shapes. LITT was administered with the NeuroBlate System. RESULTS In vivo, GNS preferentially accumulated within intracranial tumors on PET-CT at the 24- and 72-hour timepoints. AR and HP confirmed high GNS accumulation within tumor. Ex vivo, in cuboid tumor phantoms, the GNS-infused phantom heated 5.5x faster than the control, rising 0.49°C per minute compared to 0.09°C. In a split-cylinder tumor phantom with half containing GNS, the GNS-infused border heated 2x faster and the surrounding area was exposed to 30% lower temperatures. In a GNS-infused star-shaped phantom, the heat spread contoured along phantom boundaries. CONCLUSIONS Our results provide evidence for use of GNS to improve the specificity, efficiency, and potentially safety of LITT. The in vivo data support selective accumulation within intracranial tumors, and the GNS-infused phantom experiments demonstrate increased rates of heating within the tumor model, heat contouring to tumor borders, and decreased heating of surrounding regions representing normal structures.

scholarly journals Muscle and Timing-specific Functional Connectivity between the Dorsolateral Prefrontal Cortex and the Primary Motor Cortex

2013 ◽  
Vol 25 (4) ◽  
pp. 558-570 ◽  
Author(s):  
Alkomiet Hasan ◽  
Joseph M. Galea ◽  
Elias P. Casula ◽  
Peter Falkai ◽  
Sven Bestmann ◽  
...  
Keyword(s):  
Functional Connectivity ◽  
Motor Cortex ◽  
Animal Studies ◽  
Primary Motor Cortex ◽  
Adjacent Area ◽  
Left Dlpfc ◽  
Dorsolateral Prefrontal ◽  
The Difference ◽  
Selection Tasks ◽  
The Right

The pFC has a crucial role in cognitive control, executive function, and sensory processing. Functional imaging, neurophysiological, and animal studies provide evidence for a functional connectivity between the dorsolateral pFC (DLPFC) and the primary motor cortex (M1) during free choice but not instructed choice selection tasks. In this study, twin coil, neuronavigated TMS was used to examine the precise timing of the functional interaction between human left DLPFC and ipsilateral M1 during the execution of a free/specified choice selection task involving the digits of the right hand. In a thumb muscle that was not involved in the task, a conditioning pulse to the left DLPFC enhanced the excitability of the ipsilateral M1 during free selection more than specified selection 100 msec after presentation of the cue; the opposite effect was seen at 75 msec. However, the difference between free and externally specified conditions disappeared when a task-specific muscle was investigated. In this case, the influence from DLPFC was dominated by task involvement rather than mode of selection, suggesting that other processes related to movement execution were also operating. Finally, we show that the effects were spatially specific because they were absent when an adjacent area of DLPFC was stimulated. These results reveal temporally and spatially selective interactions between BA 46 and M1 that are both task and muscle specific.

scholarly journals Resection of primary motor cortex tumors: feasibility and surgical outcomes

2018 ◽  
Vol 129 (4) ◽  
pp. 961-972 ◽  
Author(s):  
Stephen T. Magill ◽  
Seunggu J. Han ◽  
Jing Li ◽  
Mitchel S. Berger
Keyword(s):  
Motor Cortex ◽  
General Anesthesia ◽  
Motor Response ◽  
Primary Motor Cortex ◽  
Extent Of Resection ◽  
Motor Deficit ◽  
Motor Deficits ◽  
Motor Mapping ◽  
Postoperative Mri ◽  
Significant Difference

OBJECTIVEBrain tumors involving the primary motor cortex are often deemed unresectable due to the potential neurological consequences that result from injury to this region. Nevertheless, we have challenged this dogma for many years and used asleep, as well as awake, intraoperative stimulation mapping to maximize extent of resection. It remains unclear whether these tumors can be resected with acceptable morbidity, whether performing the surgery with the patient awake or asleep impacts extent of resection, and how stimulation mapping influences outcomes.METHODSA retrospective chart review was performed on the senior author’s cohort to identify patients treated between 1998 and 2016 who underwent resection of tumors that were located within the primary motor cortex. Clinical notes, operative reports, and radiographic images were reviewed to identify intraoperative stimulation mapping findings and functional outcomes following tumor resection. Extent of resection was quantified volumetrically. Characteristics of patients were analyzed to identify factors associated with postoperative motor deficits.RESULTSForty-nine patients underwent 53 resections of tumors located primarily within the motor cortex. Stimulation mapping was performed in all cases. Positive cortical sites for motor response were identified in 91% of cases, and subcortical sites in 74%. Awake craniotomy was performed in 65% of cases, while 35% were done under general anesthesia. The mean extent of resection was 91%. There was no statistically significant difference in extent of resection in cases done awake compared with those done under general anesthesia. New or worsened postoperative motor deficits occurred in 32 patients (60%), and 20 patients (38%) had a permanent deficit. Of the permanent deficits, 14 were mild, 4 were moderate, and 2 were severe (3.8% of cases). Decreased intraoperative motor response and diffusion restriction on postoperative MRI were associated with permanent deficit. Awake motor mapping surgery was associated with increased diffusion signal on postoperative MRI.CONCLUSIONSResection of tumors from the primary motor cortex is associated with an increased risk of motor deficit, but most of these deficits are transient or mild and have little functional impact. Excellent extent of resection can be achieved with intraoperative stimulation mapping, suggesting that these tumors are indeed amenable to resection and should not be labeled unresectable. Injury to small perforating or en passage blood vessels was the most common cause of infarction that led to moderate or severe deficits. Awake motor mapping was not superior to mapping done under general anesthesia with regard to long-term functional outcome.

scholarly journals SURG-09. Benefits of laser interstitial thermal therapy in the treatment of biopsy-proven radiation necrosis

2021 ◽  
Vol 3 (Supplement_3) ◽  
pp. iii25-iii25
Author(s):  
Emily Lerner ◽  
Ethan Srinivasan ◽  
Eric Sankey ◽  
Matthew Grabowski ◽  
Andrew Griffin ◽  
...  
Keyword(s):  
Radiation Necrosis ◽  
Thermal Therapy ◽  
Definitive Treatment ◽  
Study Endpoint ◽  
Lesion Volume ◽  
Variable Response ◽  
Invasive Treatment ◽  
Laser Interstitial Thermal Therapy ◽  
Local Progression ◽  
Significant Difference

Abstract Introduction Laser interstitial thermal therapy (LITT) is a minimally-invasive treatment option often used for patients with deep-seated intracranial lesions. It has been implemented as a definitive treatment for radiation necrosis (RN), which occurs in 9–14% of patients after stereotactic radiosurgery (SRS) for brain metastases (BM). Medical management (MM) with steroids is a common first-line therapy, with variable response and numerous side effects, especially regarding immunotherapy. Methods Patients with biopsy-proven RN after SRS for BM who received LITT or MM at two academic centers were retrospectively reviewed. Treatment failure was defined as radiographic progression that necessitated a change in management. Measurements of total (TLV) and contrast-enhancing lesion volume (ceLV) were obtained from MRI by semi-automated analysis using the BrainLab iPlan Cranial 3.0 software. Results Seventy-two patients were followed for 10.0 (4.2–25.1) months and 57 (79%) received LITT. Steroid cessation occurred at a median of 37 days post-LITT compared to 245 days after MM (p<0.01). On Kaplan-Meier analyses, there was no significant difference between the two groups in overall survival (LITT median of 15.2 months vs 11.6 months, p = 0.60) or freedom from local progression (13.6 months vs. 7.06 months), though LITT trended to show a benefit in both metrics. When controlled for follow-up duration, patients treated with LITT were three times more likely to be weaned off steroids prior to the study endpoint compared to those who were medically managed (p=0.003). The LITT cohort demonstrated a general radiographic trend of initially increased CeLV followed by contraction, with significant decreases from pre-operative at 10–12 months (p<0.01). The MM group did not demonstrate any statistically significant radiographic trends. Conclusion These results suggest that LITT for RN significantly reduces the time to steroid cessation and characterize a stereotyped radiographic response to LITT. Future prospective studies will be important to their validation.

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