Multimodal imaging and LITT: Safety during ablation – near certainty at the end of the procedure
Jean-Marc CONSTANS | Salem BOUSSIDA
Seance of wednesday 06 march 2024 (Intérêt de la thermothérapie laser en Neurochirurgie)
DOI number : 10.26299/h3bv-xv97/emem.2024.08.05
Abstract
Laser Interstitial Thermal Therapy (LITT), a minimally invasive stereotactic and robot assisted neurosurgical approach, uses laser heat to destroy cerebral lesions under real time MRI monitoring. This MRI control allows safe use, a decreased in complication rate, better post-surgery periods.
This LITT procedure needs pre-surgery multimodal MRI with morphological, vascular, diffusional, and sometimes perfusional and functional data.
At Amiens-Picardie University Hospital, a national and European LITT center (more than 60 procedures on focal epilepsy, tremors and tumors), this assessment is supplemented by metabolic information from Magnetic Resonance Spectroscopy (MRS). These modalities offer information that could help neurosurgeons in their therapeutic decisions and evaluations. With longitudinal follow-up, MRI-MRS combination allows during surgery: better sensitivity to lesion extent evolution and the ability to adapt in real time laser parameters (intensity, pulse duration and global time duration). In immediate post-surgery: better LITT induced lesion extent (hypersignal volumes and glial, energetics, membranes or necrosis biomarker measurements). In subacute (J2-J7) and tardive post-surgery: a better safety and sometimes measurement of lesion efficacy on distal cerebral regions. Moreover, longitudinal follow-up of MRI-MRS variations could help to evaluate medium and long term LITT efficacy and early recurrence detection.
This LITT procedure needs pre-surgery multimodal MRI with morphological, vascular, diffusional, and sometimes perfusional and functional data.
At Amiens-Picardie University Hospital, a national and European LITT center (more than 60 procedures on focal epilepsy, tremors and tumors), this assessment is supplemented by metabolic information from Magnetic Resonance Spectroscopy (MRS). These modalities offer information that could help neurosurgeons in their therapeutic decisions and evaluations. With longitudinal follow-up, MRI-MRS combination allows during surgery: better sensitivity to lesion extent evolution and the ability to adapt in real time laser parameters (intensity, pulse duration and global time duration). In immediate post-surgery: better LITT induced lesion extent (hypersignal volumes and glial, energetics, membranes or necrosis biomarker measurements). In subacute (J2-J7) and tardive post-surgery: a better safety and sometimes measurement of lesion efficacy on distal cerebral regions. Moreover, longitudinal follow-up of MRI-MRS variations could help to evaluate medium and long term LITT efficacy and early recurrence detection.