Magnetic Resonance-Guided Laser Interstitial Thermal Therapy for Brainstem Pathologies.

Objective: Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) is a minimally invasive and effective treatment option that can potentially treat deep-seated pathologies in cases without safe open surgical corridors. In the present report, we have described our experience using MRgLITT for brainstem pathologies.

Methods: A retrospective medical record review and analysis were conducted for all patients who had undergone MRgLITT for pathologies within or closely surrounding the brainstem between 2011 and 2020. The patients had undergone stereotactic laser placement in the operating suite and were transported to the magnetic resonance imaging suite for laser ablation with real-time monitoring. The demographics, operative parameters, and complications were recorded.

Results: A total of 12 patients had undergone MRgLITT for brainstem pathologies. The average age of the patients was 47.6 years (range, 4-75 years). The pathologies included both primary and metastatic intracranial tumors. The average preablation volume of the targets was 2.4 ± 0.50 cm. The average ablation time was 324.3 ± 60.7 seconds, and the average postablation volume was 2.92 ± 0.53 cm. One perioperative mortality was directly related to the procedure and 7 patients developed postoperative deficits. Two patients had experienced a recurrence after MRgLITT and opted to undergo additional alternative treatment.

Conclusions: The brainstem represents formidable territory even for minimally invasive procedures. The overall morbidity and mortality has remained high, and the probability of achieving a meaningful outcome must be carefully assessed.