NT-15 * STEREOTACTIC LASER THERMAL ABLATION OF RECURRENT POSTERIOR FOSSA METASTATIC LESION: DESCRIPTION OF NEW TECHNOLOGY FOR INFRATENTORIAL TUMORS REFRACTORY TO CONVENTIONAL THERAPIES

J. K. Eliyas, J. Bailes, R. Merrell, S. O'Leary
2014 Neuro-Oncology  
BACKGROUND: Stereotactic radiofrequency thermal ablation is a minimally invasive innovative technique that achieves real time tumor destruction. The procedure is safe and effective with real time MRI feedback. We describe the use of stereotactic radio-frequency thermal ablation of posterior fossa metastatic lesion that was refractory to surgical resection and radiosurgery. METHODS: A 67-year-old lady with pulmonary adenocarcinoma developed recurrent metastatic left cerebellar lesion, which was
more » ... efractory to surgery and radiosurgery. The patient was symptomatic from this lesion and required at least debulking to improve quality of life. She underwent stereotactic radiofrequency thermal ablation using frame-less steretotaxy. Pre-operative imaging using fiducials screwed to the skull was registered in a navigation system that aided in precise placement of skin incision. A specially engineered precision access device was used to drill a 3.2-mm hole in the optimum trajectory and to place a 1.65-mm diameter laser applicator and probe. RESULTS: After confirmation of probe placement with MRI, ablation was accomplished over 2.65 x 1.22 cm of lesion under multi-planar real -time thermal imaging. The tumor approximated facial nerve exit at the brainstem. Real-time feedback with safety markers placed along the seventh cranial nerve exit zone at brainstem and middle cerebellar peduncle regulated dose and duration of therapy. The patient suffered no new neurological deficit and was discharged home the following day without any complication. At 6-month follow-up, the patient continued to show good tumor control, without new symptoms, remaining neurologically and radiologically unchanged. CONCLUSIONS: This case illustrates the utility of radio-frequency thermal ablation for metastatic lesions in the infratentorial space especially when conventional therapies have been either exhausted or found unsuitable. With safety markers protecting brainstem and cranial nerves, good tumor control can be achieved without suffering significant neurological deficit. Also, minimal invasiveness and negligible risk advocate for possibility of multiple sessions, performed safely.
doi:10.1093/neuonc/nou265.14 fatcat:bijzlxpwyzab7j4opab3q4dtvy