A Systematic Review and Meta-Analysis of Studies Examining the Use of Brain Laser Interstitial Thermal Therapy versus Craniotomy for the Treatment of High-Grade Tumors in or near Areas of Eloquence: An Examination of the Extent of Resection and Major Complication Rates Associated with Each Type of Surgery

Abstract

Background: The extent of resection (EOR) of high-grade gliomas (WHO grade III or IV) in or near areas of eloquence is associated with overall patient survival, but with higher major neurocognitive complications. Methods: A systematic review and meta-analysis was undertaken of the peer-reviewed literature in order to identify studies which examined EOR or extent of ablation (EOA) and major complications (defined as neurocognitive or functional complications which last >3 months duration after surgery) associated with either brain laser interstitial thermal therapy (LITT) or open craniotomy in high-grade tumors in or near areas of eloquence. Results: Eight studies on brain LITT (n = 79 patients) and 12 craniotomy studies (n = 1,036 patients) were identified which examined either/both EOR/EOA and complications. Meta-analysis demonstrated an EOA/EOR of 85.4 ± 10.6% with brain LITT versus 77.0 ± 40% with craniotomy (mean difference: 8%; 95% CI: 2-15; p = 0.01; inverse variance, random effects model). Meta-analysis of proportions of major complications for each individual therapy demonstrated major complications of 5.7% (95% CI: 1.8-11.6) and 13.8% (95% CI: 10.3-17.9) for LITT and craniotomy, respectively. Conclusion: In patients presenting with high-grade gliomas in or near areas of eloquence, early results demonstrate that brain LITT may be a viable surgical alternative.

Laser Ablation of Abnormal Neurological Tissue Using Robotic NeuroBlate System (LAANTERN): 12-Month Outcomes and Quality of Life After Brain Tumor Ablation

“… 17-19 LITT is a surgical tool, and in the appropriate-use scenarios, it can achieve a similar extent of resection to craniotomy with a lower risk of complications. 20 Length of stay, readmission rates, and cost were also favorable to those reported in the literature for craniotomy. 21-24 …”

Laser Ablation of Abnormal Neurological Tissue Using Robotic NeuroBlate System (LAANTERN): 12-Month Outcomes and Quality of Life After Brain Tumor Ablation

“… 17-19 LITT is a surgical tool, and in the appropriate-use scenarios, it can achieve a similar extent of resection to craniotomy with a lower risk of complications. 20 Length of stay, readmission rates, and cost were also favorable to those reported in the literature for craniotomy. 21-24 …”

An analysis of functional outcomes following laser interstitial thermal therapy for recurrent high-grade glioma

“…[29][30][31] Instead, this finding adds to the evidence shown in direct comparisons between LITT and open surgery that suggests a role for LITT in patients with low baseline functional status. 26 Nearly half of the patients in this study demonstrated a new or increased need for corticosteroids after undergoing LITT. This is not surprising given that LITT has been shown to open the blood-brain barrier, a property that is under investigation to augment drug delivery.…”

Current status and research progress of minimally invasive treatment of glioma

“…indicated that the median survival of LITT treatment was 7 months in patients with corpus callosum HGG, compared with surgical resection of about 65%. In this study, the tumors were larger (≥Patients with 15 cm 3 ) were 6 times more likely to develop complications ( 40 ).…”

Laser Ablation of Abnormal Neurological Tissue Using Robotic NeuroBlate System (LAANTERN): 12-Month Outcomes and Quality of Life After Brain Tumor Ablation

“… 17-19 LITT is a surgical tool, and in the appropriate-use scenarios, it can achieve a similar extent of resection to craniotomy with a lower risk of complications. 20 Length of stay, readmission rates, and cost were also favorable to those reported in the literature for craniotomy. 21-24 …”

An analysis of functional outcomes following laser interstitial thermal therapy for recurrent high-grade glioma

“…[29][30][31] Instead, this finding adds to the evidence shown in direct comparisons between LITT and open surgery that suggests a role for LITT in patients with low baseline functional status. 26 Nearly half of the patients in this study demonstrated a new or increased need for corticosteroids after undergoing LITT. This is not surprising given that LITT has been shown to open the blood-brain barrier, a property that is under investigation to augment drug delivery.…”

Current status and research progress of minimally invasive treatment of glioma

“…indicated that the median survival of LITT treatment was 7 months in patients with corpus callosum HGG, compared with surgical resection of about 65%. In this study, the tumors were larger (≥Patients with 15 cm 3 ) were 6 times more likely to develop complications ( 40 ).…”

Laser Ablation of Abnormal Neurological Tissue Using Robotic NeuroBlate System (LAANTERN): 12-Month Outcomes and Quality of Life After Brain Tumor Ablation

“… 17-19 LITT is a surgical tool, and in the appropriate-use scenarios, it can achieve a similar extent of resection to craniotomy with a lower risk of complications. 20 Length of stay, readmission rates, and cost were also favorable to those reported in the literature for craniotomy. 21-24 …”

An analysis of functional outcomes following laser interstitial thermal therapy for recurrent high-grade glioma

“…[29][30][31] Instead, this finding adds to the evidence shown in direct comparisons between LITT and open surgery that suggests a role for LITT in patients with low baseline functional status. 26 Nearly half of the patients in this study demonstrated a new or increased need for corticosteroids after undergoing LITT. This is not surprising given that LITT has been shown to open the blood-brain barrier, a property that is under investigation to augment drug delivery.…”

Current status and research progress of minimally invasive treatment of glioma

“…indicated that the median survival of LITT treatment was 7 months in patients with corpus callosum HGG, compared with surgical resection of about 65%. In this study, the tumors were larger (≥Patients with 15 cm 3 ) were 6 times more likely to develop complications ( 40 ).…”