Abstract Date: 5/2/2015
Claudio Tatsui, MD
Jonathan Sellin, MD
Jason Stafford, PhD
Jing Li, MD
Jeffrey Weinberg, MD
Ganesh Rao, MD
Laurence Rhines, MD (Houston, TX)
High grade malignant spinal cord compression is commonly managed with a combination of surgery, aiming removal of the epidural tumor, followed by stereotactic spinal radiosurgery (SSRS), aiming local tumor control. We introduce the use of laser interstitial thermotherapy as an alternative to separation surgery prior to SSRS. Tumoral ablation is monitored and controlled in real time by thermal MR imaging. We present our experience with this technique in conjunction with SSRS to improve local control of epidural metastasis of radio-resistant tumors.
Fourteen patients with high degree of epidural compression due to radio-resistant tumors were selected. Visual analog pain score (VAS) and quality of life score (QoL) were obtained before, within 30 days and within 60 days after the procedure. The laser probe was positioned with standard spinal image guidance at a distance of 6mm from the dura mater. Real time fast spin echo MR sequences co-planar with anatomical T2 images were overlaid to monitor the tissue temperature and damage in the region of interest. All patients received post-op SSRS. Epidural spinal cord compression was graded according to the Epidural Spinal Cord Compression classification proposed by Bilsky et al. in pre and post procedure MRI.
Median VAS was 6; 3; 2 and median QoL scores were 49%; 63%; 61.5% respectively at pre-op, within 30, and 60 days after treatment. Twelve out of fourteen patients had improvement in the degree of spinal cord compression on imaging follow up 2 months after the procedure.
We present laser interstitial thermotherapy as a minimally invasive alternative to separation surgery in the management of spinal metastasis, achieving excellent local control with low morbidity and fast improvement in pain and quality of life of our patients.
Article ID: AA-31539