Supralesional Ablation Volumes Are Feasible in the Posterior Fossa and May Provide Enhanced Symptomatic Relief

Evan Luther, Victor M. Lu, Alexis A. Morell, Turki Elarjani, Samuel Mansour, Nikolas Echeverry, Wendy Gaztanaga, Hunter King, David McCarthy, Daniel G. Eichberg, Ashish Shah, Joshua Burks, Gurvinder Kaur, Michael E. Ivan, Ricardo J. Komotar

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: Laser interstitial thermal therapy (LITT) for posterior fossa lesions remains rare as the small size of the infratentorial compartment, proximity to the brainstem, and thickness/angulation of the occipital bone creates barriers to procedural success. Furthermore, evaluation of the effect of ablation volume on outcomes is limited. OBJECTIVE: To analyze our institutional experience with LITT in the posterior fossa stratifying perioperative and long-term outcomes by ablation volumes. METHODS: Seventeen patients with posterior fossa lesions treated with LITT from 2013 to 2020 were identified. Local progression-free survival (PFS), overall survival, steroid dependence, and edema reduction were evaluated with Kaplan-Meier analysis grouped by ablation volume. Preoperative, postoperative, and last known Karnofsky Performance Status (KPS) were compared using a matched paired t test. RESULTS: No differences in pathology, preoperative KPS, or preoperative lesion volume were found between patients with total (100%-200% increase in pre-LITT lesion volume) versus radical (>200% increase in pre-LITT lesion volume) ablations. Patients who underwent radical ablation had a higher postoperative KPS (93 vs 82, P =. 02) and higher KPS (94 vs 87, P =. 04) and greater reduction in perilesional edema at last follow-up (P =. 01). Median follow-up was 80.8 wk. CONCLUSION: Despite obvious anatomical challenges, our results demonstrate that radical ablations are both feasible and safe in the posterior fossa. Furthermore, radical ablations may lead to greater decreases in perilesional edema and improved functional status both immediately after surgery and at last follow-up. Thus, LITT should be considered for patients with otherwise unresectable or radioresistant posterior fossa lesions.

Original languageEnglish (US)
Pages (from-to)418-425
Number of pages8
JournalOperative Neurosurgery
Volume21
Issue number6
DOIs
StatePublished - Dec 1 2021

Keywords

  • Brain metastasis
  • Brain tumor
  • Laser interstitial thermal therapy
  • Oncology
  • Posterior fossa
  • Primary brain tumor
  • Radiation necrosis

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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