A customized 3D implant to target laser interstitial thermal therapy ablation of a posterior fossa mass. (August 2021)

• Record Type: Journal Article
• Authors: Kozlowski, Julia; VanKoevering, Kyle; Heth, Jason A.
• Is Part Of: Journal of clinical neuroscience. Volume 90(2021)
• Page Start: 238
• Page End: 243
• Publication Date: 2021-08
• Subjects: 3D-printed implant -- Laser interstitial thermal therapy -- LITT -- Cerebellar metastasis -- Surgical targeting; Brain -- Surgery -- Periodicals; Neurosciences -- Periodicals; Nervous system -- Surgery -- Periodicals; Brain -- surgery -- Periodicals; Neurosurgical Procedures -- Periodicals; Neurosciences -- Periodicals; Electronic journals; 616.8
• DOI: 10.1016/j.jocn.2021.05.064
• Languages: English
• ISSNs: 0967-5868

Abstract

Highlights: LITT is difficult after craniectomy due to lack of bony surface to anchor the bolt. A 3D-printed implant was used to enable LITT targeting of a posterior fossa lesion. The customized plate had a built-in bolt trajectory that aligned with the tumor. The customized plate was implemented under the FDA expanded access pathway. This strategy enables use of LITT in patients who would not otherwise be candidates. Abstract: Laser interstitial thermal therapy (LITT) is a minimally invasive neurosurgical technique that has been demonstrated to successfully ablate intracranial tumors. While LITT for supratentorial lesions can often be straightforward, ablation of infratentorial lesions can be difficult with current targeting technologies and instrumentation. The anatomical difficulty of targeting posterior fossa masses can be further complicated in patients who have had a prior craniectomy or other procedure that removed the bone that is required to set the surgical trajectory. This article describes use of a three-dimensional (3D)–printed customized surgical implant to improve and enable targeting of posterior fossa lesions using LITT, particularly in the setting of prior craniectomy. A 3D-printed implant was customized for a patient with a history of metastatic lung cancer and prior posterior fossa craniectomy who presented for treatment of a progressively enlarging contrast-enhancing lesion in the right cerebellar hemisphere. The device included a built-in bolt trajectory for LITT ablation. The temporary implant was successfully fabricated for use with laser ablation of a right cerebellar mass. Three potential trajectories for the LITT bolt were incorporated into the temporary implant, but only the primary trajectory was utilized. Laser ablation was performed with the implant and a SideFire laser probe. Customized 3D-printed implants can enable the use of LITT for patients who would not otherwise be candidates.