Neurosurg Focus. 2020 Oct;49(4):E12. doi: 10.3171/2020.7.FOCUS20462.
There is a paucity of studies assessing the use of MR-guided laser interstitial thermal therapy (LITT), specifically in the elderly population. The aim of this study was to evaluate the safety of LITT for brain tumors in geriatric patients.
Geriatric patients (≥ 65 years of age) treated with LITT for intracranial tumors at a single institution between January 2011 and November 2019 were retrospectively identified. The authors grouped patients into two distinct age cohorts: 65-74 years (group 1) and 75 years or older (group 2). Baseline characteristics, operative parameters, postoperative course, and morbidity were recorded for each patient.
Fifty-five geriatric patients underwent 64 distinct LITT procedures for brain tumors. The majority of lesions (40 [62.5%]) treated were recurrent brain metastases or radiation necrosis. The median modified frailty index was 0.1 (low frailty; range 0-0.4) for patients in group 1 and 0.2 (intermediate frailty; range 0-0.4) for patients in group 2 (p > 0.05). The median hospital length of stay (LOS) was 1 day (IQR 1-2 days); there was no significant difference in LOS between the age groups. The hospital stay was significantly longer in patients who presented with a neurological symptom and in those who experienced a postoperative complication. The majority of patients (43 [68.3%] of 63 cases) were fit for discharge to their preoperative accommodation following LITT. The rate of discharge to home was not significantly different between the age groups. Those discharged to rehabilitation facilities were more likely to have presented with a neurological symptom. Nine patients (14.1% of cases) were found to have acute neurological complications following LITT, with nearly all patients showing complete or partial recovery at follow-up. The 30-day postoperative mortality rate was 1.6% (1 case). The complication and 30-day postoperative mortality rates were not significantly different between the two age groups.
LITT can be considered a minimally invasive and safe neurosurgical procedure for the treatment of intracranial tumors in geriatric patients. Careful preoperative preparation and postoperative care is essential as LITT is not without risk. Appropriate patient selection for cranial surgery is essential, because neurosurgeons are treating an increasing number of elderly patients, but advanced age alone should not exclude patients from LITT without considering frailty and comorbidities.
评估磁共振引导激光间质热疗（LITT）在老年患者中的安全性，特别是在评估大脑肿瘤治疗方面。
回顾性分析 2011 年 1 月至 2019 年 11 月期间在一家机构接受 LITT 治疗颅内肿瘤的老年患者。作者将患者分为两个不同的年龄组：65-74 岁（组 1）和 75 岁或以上（组 2）。记录每位患者的基线特征、手术参数、术后过程和发病率。
55 例老年患者行 64 例 LITT 治疗颅内肿瘤。治疗的大部分病变（40 例[62.5%]）为复发性脑转移瘤或放射性坏死。组 1 患者的平均改良虚弱指数为 0.1（低虚弱；范围 0-0.4），组 2 患者为 0.2（中等虚弱；范围 0-0.4）（p＞0.05）。中位住院时间（LOS）为 1 天（IQR 1-2 天）；两组之间的 LOS 无显著差异。出现神经症状和术后并发症的患者住院时间较长。大多数患者（63 例中的 43 例[68.3%]）在 LITT 后适合出院到术前住所。两组之间的出院回家率无显著差异。出院到康复设施的患者更有可能出现神经症状。9 例（63 例中的 14.1%）患者在 LITT 后出现急性神经并发症，所有患者在随访时均显示完全或部分恢复。术后 30 天死亡率为 1.6%（1 例）。两组之间的并发症和术后 30 天死亡率无显著差异。
LITT 可被视为治疗老年患者颅内肿瘤的一种微创、安全的神经外科手术。由于 LITT 并非没有风险，因此术前仔细准备和术后护理至关重要。选择合适的颅部手术患者至关重要，因为神经外科医生治疗的老年患者越来越多，但高龄本身不应排除因虚弱和合并症而不考虑接受 LITT 的患者。
