Page 62 - MEGIN Book Of Abstracts - 2023

Brain Tumors

Neurophysiology-Guided Laser Interstitial Thermal METHODS We developed a synergistic approach for
Therapy: A Synergistic Approach For Motor neurophysiology-guided LITT based on state-of-the-art
Function Preservation. Technical Note (2022) technologies, namely, magnetoencephalography, dif-
fusion tensor imaging, and intraoperative neurophysi-
Del Bene, Massimiliano; Carone, Giovanni; Porto, ologic monitoring.
Edoardo; Barbotti, Arianna; Messina, Giuseppe; Tringali,
Giovanni; Rossi, Davide; Lanteri, Paola; Togni, Ramona; RESULTS As a result, we improved the planning phase
Demichelis, Greta; Aquino, Domenico; Doniselli, Fabio thanks to a more precise representation of functional
Martino; DiMeco, Francesco; Casali, Cecilia structures that allows the simulation of different
trajectories and the identification of the most suit-
Department of Neurosurgery, Fondazione IRCCS Istituto able trajectory to treat the lesion while respecting the
Neurologico Carlo Besta, Milan, Italy; Department of Ex- functional boundaries. Catheter insertion is conducted
perimental Oncology, IEO, European Institute of Oncology under continuous neurophysiologic feedback and the
IRCCS, Milan, Italy; Neurophysiopathology Unit, Diagnostic ablation phase is modeled on the functional boundar-
and Technology Department, Fondazione IRCCS, Istituto ies identified by stimulation, allowing it to be extremely
Neurologico Carlo Besta, Milan, Italy; Neuroradiology Unit, accurate.
Diagnostic and Technology Department, Fondazione IRCCS
Istituto Neurologico Carlo Besta, Milan, Italy; Department of CONCLUSIONS An integrated approached guided by
Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo neurophysiology is able to reduce the surgical morbid-
Besta, Milan, Italy; Department of Pathophysiology and ity even in a relatively accurate technique such as LITT.
Transplantation, University of Milan, Milan, Italy; Depart- To the best of our knowledge, this represents the first
ment of Neurological Surgery, Johns Hopkins Medical School, report on this synergistic approach which could really
Baltimore, Maryland, USA; Department of Neurosurgery, impact the treatment of tumors in eloquent areas.
Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Future studies are needed in the effort to implement
Italy. Electronic address: [email protected] this approach in functional or epilepsy neurosurgery as
well.
BACKGROUND Laser interstitial thermal therapy (LITT)
is a minimally invasive ablative technique with specific Keywords: Imaging, LITT, MEG, Neuro-oncology, Neuro-
indications for neuro-oncology, especially in the case physiology, Rehearsal
of lesions in eloquent areas. Even being performed
through a small catheter under stereotactic conditions, World neurosurgery (2022), Vol. 168 (36202344) (1
the risk of damaging vital structures such as white mat- citation)
ter tracts or cortical eloquent areas is not negligible.
The mechanism of damage can be related to catheter
insertion or to excessive laser ablation. An accurate Regional healthy brain activity, glioma occurrence
preoperative workup, aimed at locating the eloquent and symptomatology (2022)
structures, can be combined with a real-time intraop-
erative neurophysiologic monitoring to reduce surgical Numan, Tianne; Breedt, Lucas C; Maciel, Bernardo de
morbidity while maximizing the efficacy of LITT. A P C; Kulik, Shanna D; Derks, Jolanda; Schoonheim,
Menno M; Klein, Martin; de Witt Hamer, Philip C; Miller,

 ontents  Index 41
C