Berke Chandler N, Khalafallah Adham M, Gurses Muhammet Enes, Lu Victor M, Ivan Michael E, Komotar Ricardo J, Shah Ashish H
Department of Neurological Surgery, University of Miami, Miller School of Medicine, Miami, Florida, USA.
Oper Neurosurg. 2025 Jun 24. doi: 10.1227/ons.0000000000001668.
Glioblastoma (GBM) is the most common and aggressive primary malignant brain tumor in adults with a median overall survival of 15.6 months. Despite advancements, 5-year survival rates have not significantly improved. Laser interstitial thermal therapy (LITT) has been used to treat both newly diagnosed (nGBM) and recurrent GBM (rGBM) with demonstrable safety and efficacy. Traditionally, LITT has been limited to smaller lesions given physical and thermal constraints. We present 2 case examples of a novel, hybrid treatment approach to GBM, using both surgery and laser ablation as part of a staged procedure.
Two geriatric (older than 65 years) patients with nGBM or rGBM were treated with surgical resection followed by LITT the subsequent day. Both patients underwent preoperative MRI showing multifocal disease with a dominant component, causing mass effect in the second case, and an unresectable component.
The first case underwent surgical resection of a large, multicentric rGBM in the parieto-occipital region, followed by LITT of an unresectable lesion in the inferior temporal gyrus. The second patient underwent surgical resection of the dominant temporal lobe component and LITT of the insular component. Neither patient had intraoperative or ablation complications. Both patients had stable postoperative neurological examinations and were discharged on the day after ablation, with no new deficits at follow-up.
The prognosis for GBM remains dismal despite attempts at advancements in patient management. Surgical resection is a critical component of the GBM treatment paradigm, although, alone, is not sufficient for maximal therapeutics in many patients. LITT is a minimally invasive means of cytoreduction that has shown promise for improving GBM outcomes. We demonstrate a novel, hybrid approach to GBM using hybrid surgical resection and LITT in a staged procedure to overcome traditional constraints of both open resection or LITT alone.
胶质母细胞瘤（GBM）是成人中最常见且侵袭性最强的原发性恶性脑肿瘤，中位总生存期为15.6个月。尽管取得了进展，但5年生存率并未显著提高。激光间质热疗（LITT）已被用于治疗新诊断的（nGBM）和复发性GBM（rGBM），具有可证明的安全性和有效性。传统上，由于物理和热限制，LITT仅限于较小的病变。我们展示了2例采用手术和激光消融作为分期手术一部分的GBM新型联合治疗方法的病例。
两名老年（65岁以上）nGBM或rGBM患者先接受手术切除，随后次日接受LITT治疗。两名患者术前MRI均显示多灶性病变，其中一例有一个主要成分，在第二例中导致占位效应，还有一个不可切除的成分。
第一例患者接受了顶枕区大型多中心rGBM的手术切除，随后对颞下回不可切除的病变进行了LITT治疗。第二例患者接受了优势颞叶成分的手术切除和岛叶成分的LITT治疗。两名患者均未出现术中或消融并发症。两名患者术后神经检查均稳定，消融后次日出院，随访时无新的神经功能缺损。
尽管在患者管理方面不断取得进展，但GBM的预后仍然不佳。手术切除是GBM治疗模式的关键组成部分，不过，单独手术对许多患者来说不足以实现最大程度的治疗效果。LITT是一种微创性细胞减灭手段，已显示出改善GBM治疗效果的前景。我们展示了一种GBM的新型联合方法，即采用分期手术中的联合手术切除和LITT，以克服单纯开放切除或LITT的传统限制。
