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Program Information

A Novel Workflow for Awake Patient Laser Ablation

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M Shang

M Shang*, D Laurent , S Oliveria , F Bova , Univ Florida, Gainesville, FL


MO-L-GePD-J(B)-2 (Monday, July 31, 2017) 1:15 PM - 1:45 PM Room: Joint Imaging-Therapy ePoster Lounge - B

Purpose: Laser Interstitial Thermal Therapy (LITT) is a laser ablation procedure used to treat a variety of clinical targets. In previous clinical implementations of the LITT system purchased by our institution, the patient is anesthetized throughout the procedure and, at time of ablation, fixed to the Magnetic Resonance (MR) table using MR compatible pins and ring. Due to facility restrictions, we have created a workflow in which the patient is awake throughout the entire procedure and does not require rigid fixation during the ablation.

Methods: Before treatment day, in the preplanning phase, a high-resolution MR scan of the patient’s head is obtained. The neurosurgeon then plans the laser probe trajectory on this scan. If it is suspected that the planned trajectory will interfere with the stereotactic arc placement, a 3D printed guide is designed to assist in frame placement. On the day of the procedure, a Brown-Roberts-Wells (BRW) head ring is fixed to the patient’s skull and a stereotactic Computed Tomography (CT) scan is obtained and processed. The preoperative MR scan is fused to the stereotactic CT scan and an affine transform between the two are established. After the fusion accuracy is verified, the affine transform is applied to the preoperative plan, allowing implementation of a Cosman-Roberts-Wells (CRW) arc guidance frame. Later in the operating room, the laser skull fixation hardware is implanted. The stereotactic arc is then removed and the patient is transported to the MR scanner. The patient is relocated to MR scanner and is immobilized using a combination of body molds and thermoplastic masks.

Results: All 15 institution cases that have implemented this novel workflow have been successful.

Conclusion: A novel workflow was developed allowing LITT administration to awake patients. Improvements include 3D printed trajectory-fixation guides, laser probe stereotactic placement, and custom MR head and body immobilization.

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