Endoscopic laser ablation of clival chordoma with magnetic resonance-guided laser induced thermal therapy
Background: Chordomas are rare malignant tumors that are difficult to treat and have high recurrence rates despite aggressive therapy. Objectives: We present the first case of a patient with a clival chordoma in which complete tumor ablation was achieved using Magnetic Resonance guided Laser Induced...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2014-12-01
|
| Series: | Interdisciplinary Neurosurgery |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2214751914000322 |
| _version_ | 1811282253636960256 |
|---|---|
| author | James Barrese Xiaonan R. Sun Nitesh Patel Pinakin Jethwa Shabbar F. Danish |
| author_facet | James Barrese Xiaonan R. Sun Nitesh Patel Pinakin Jethwa Shabbar F. Danish |
| author_sort | James Barrese |
| collection | DOAJ |
| description | Background: Chordomas are rare malignant tumors that are difficult to treat and have high recurrence rates despite aggressive therapy.
Objectives: We present the first case of a patient with a clival chordoma in which complete tumor ablation was achieved using Magnetic Resonance guided Laser Induced Thermal Therapy (LITT) delivered via an endoscopic endonasal approach. We analyzed the safety and feasibility of this approach and quantified the response of this pathology to thermal energy. This novel technique is intended to provide chordoma patients with an alternative to surgery and radiotherapy.
Methods: A 54 year-old female with a newly diagnosed clival chordoma elected MRI- guided LITT. She underwent placement of the laser catheter into the chordoma via an endoscopic endonasal approach. With real-time MR thermometry monitoring, laser-generated thermal energy was delivered to the tumor. We defined several parameters to quantify the thermal ablation response: the thermal damage ratio and the thermal ablation constant.
Results: Post procedure contrast-enhanced MRI demonstrated a complete thermal ablation of the mass. The patient tolerated the procedure well and is being followed with serial imaging. The tumor continues to regress beyond 4 months. Additionally, chordoma cells seem to be sensitive to LITT, as indicated by a complete ablation in less than 60 s.
Conclusion: The endoscopic endonasal approach to MRI-guided laser ablation is both technically feasible and safe. As a result, this therapy may be a useful alternative in hard-to-reach chordomas, or in recurrent cases that have failed other conventional treatment modalities. |
| first_indexed | 2024-04-13T01:49:21Z |
| format | Article |
| id | doaj.art-37235cc2130e45a590ef594651a4be0a |
| institution | Directory Open Access Journal |
| issn | 2214-7519 |
| language | English |
| last_indexed | 2024-04-13T01:49:21Z |
| publishDate | 2014-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Interdisciplinary Neurosurgery |
| spelling | doaj.art-37235cc2130e45a590ef594651a4be0a2022-12-22T03:07:56ZengElsevierInterdisciplinary Neurosurgery2214-75192014-12-0114768010.1016/j.inat.2014.06.006Endoscopic laser ablation of clival chordoma with magnetic resonance-guided laser induced thermal therapyJames Barrese0Xiaonan R. Sun1Nitesh Patel2Pinakin Jethwa3Shabbar F. Danish4Department of Neurological Surgery, Rutgers University – New Jersey Medical School, Newark, NJ, USADivision of Neurosurgery, Rutgers University – Robert Wood Johnson Medical School, New Brunswick, NJ, USADepartment of Neurological Surgery, Rutgers University – New Jersey Medical School, Newark, NJ, USADepartment of Neurological Surgery, Rutgers University – New Jersey Medical School, Newark, NJ, USADivision of Neurosurgery, Rutgers University – Robert Wood Johnson Medical School, New Brunswick, NJ, USABackground: Chordomas are rare malignant tumors that are difficult to treat and have high recurrence rates despite aggressive therapy. Objectives: We present the first case of a patient with a clival chordoma in which complete tumor ablation was achieved using Magnetic Resonance guided Laser Induced Thermal Therapy (LITT) delivered via an endoscopic endonasal approach. We analyzed the safety and feasibility of this approach and quantified the response of this pathology to thermal energy. This novel technique is intended to provide chordoma patients with an alternative to surgery and radiotherapy. Methods: A 54 year-old female with a newly diagnosed clival chordoma elected MRI- guided LITT. She underwent placement of the laser catheter into the chordoma via an endoscopic endonasal approach. With real-time MR thermometry monitoring, laser-generated thermal energy was delivered to the tumor. We defined several parameters to quantify the thermal ablation response: the thermal damage ratio and the thermal ablation constant. Results: Post procedure contrast-enhanced MRI demonstrated a complete thermal ablation of the mass. The patient tolerated the procedure well and is being followed with serial imaging. The tumor continues to regress beyond 4 months. Additionally, chordoma cells seem to be sensitive to LITT, as indicated by a complete ablation in less than 60 s. Conclusion: The endoscopic endonasal approach to MRI-guided laser ablation is both technically feasible and safe. As a result, this therapy may be a useful alternative in hard-to-reach chordomas, or in recurrent cases that have failed other conventional treatment modalities.http://www.sciencedirect.com/science/article/pii/S2214751914000322ChordomaLaser ablationEndoscopy |
| spellingShingle | James Barrese Xiaonan R. Sun Nitesh Patel Pinakin Jethwa Shabbar F. Danish Endoscopic laser ablation of clival chordoma with magnetic resonance-guided laser induced thermal therapy Interdisciplinary Neurosurgery Chordoma Laser ablation Endoscopy |
| title | Endoscopic laser ablation of clival chordoma with magnetic resonance-guided laser induced thermal therapy |
| title_full | Endoscopic laser ablation of clival chordoma with magnetic resonance-guided laser induced thermal therapy |
| title_fullStr | Endoscopic laser ablation of clival chordoma with magnetic resonance-guided laser induced thermal therapy |
| title_full_unstemmed | Endoscopic laser ablation of clival chordoma with magnetic resonance-guided laser induced thermal therapy |
| title_short | Endoscopic laser ablation of clival chordoma with magnetic resonance-guided laser induced thermal therapy |
| title_sort | endoscopic laser ablation of clival chordoma with magnetic resonance guided laser induced thermal therapy |
| topic | Chordoma Laser ablation Endoscopy |
| url | http://www.sciencedirect.com/science/article/pii/S2214751914000322 |
| work_keys_str_mv | AT jamesbarrese endoscopiclaserablationofclivalchordomawithmagneticresonanceguidedlaserinducedthermaltherapy AT xiaonanrsun endoscopiclaserablationofclivalchordomawithmagneticresonanceguidedlaserinducedthermaltherapy AT niteshpatel endoscopiclaserablationofclivalchordomawithmagneticresonanceguidedlaserinducedthermaltherapy AT pinakinjethwa endoscopiclaserablationofclivalchordomawithmagneticresonanceguidedlaserinducedthermaltherapy AT shabbarfdanish endoscopiclaserablationofclivalchordomawithmagneticresonanceguidedlaserinducedthermaltherapy |