Overcoming the challenge of a thin skull in a 2-year-old patient undergoing laser interstitial thermal therapy using an individualized stereotactic platform: illustrative case

Spencer Lau Department of Neurosurgery, University of Nebraska Medical Center, Omaha, Nebraska; and

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Joseph Menousek Department of Neurosurgery, University of Nebraska Medical Center, Omaha, Nebraska; and

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Tyler Pistone Department of Neurosurgery, University of Nebraska Medical Center, Omaha, Nebraska; and

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Arnett Klugh III Department of Neurosurgery, University of Nebraska Medical Center, Omaha, Nebraska; and
Children’s Nebraska, Omaha, Nebraska

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Afshin Salehi Department of Neurosurgery, University of Nebraska Medical Center, Omaha, Nebraska; and
Children’s Nebraska, Omaha, Nebraska

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BACKGROUND

Ependymoma is the third most common pediatric brain tumor that can present with headaches, cranial nerve deficits, nausea, vomiting, and ataxia. Current treatment is maximal safe resection followed by radiation therapy. More recently, laser interstitial thermal therapy (LITT) has become an alternative to traditional resection. In this report, the authors describe the utilization of a single-use, patient-specific stereotactic platform for the treatment of supratentorial ependymoma with LITT.

OBSERVATIONS

A 2-year-old female had a complex history of supratentorial ependymoma after multiple craniotomies for repeated tumor progression and ventriculoperitoneal shunt placement. Imaging demonstrated an enlarging, complex, enhancing mass in the right occipital region. LITT was decided on for treatment. Given the thinness of the patient’s skull, which precluded traditional means of stereotaxy, the authors elected to use a personalized stereotactic platform. Immediate postoperative imaging captured complete laser ablation of the tumor, with long-term imaging demonstrating a decreased tumor size.

LESSONS

Individualized stereotactic platforms are increasingly used in adult populations, but pediatric use continues to be infrequent. In this report, the authors present the youngest reported case using a personalized stereotactic platform and show the effectiveness of this system for performing LITT in the youngest of populations with very thin skulls.

ABBREVIATIONS

CT = computed tomography; LITT = laser interstitial thermal therapy; MRI = magnetic resonance imaging

BACKGROUND

Ependymoma is the third most common pediatric brain tumor that can present with headaches, cranial nerve deficits, nausea, vomiting, and ataxia. Current treatment is maximal safe resection followed by radiation therapy. More recently, laser interstitial thermal therapy (LITT) has become an alternative to traditional resection. In this report, the authors describe the utilization of a single-use, patient-specific stereotactic platform for the treatment of supratentorial ependymoma with LITT.

OBSERVATIONS

A 2-year-old female had a complex history of supratentorial ependymoma after multiple craniotomies for repeated tumor progression and ventriculoperitoneal shunt placement. Imaging demonstrated an enlarging, complex, enhancing mass in the right occipital region. LITT was decided on for treatment. Given the thinness of the patient’s skull, which precluded traditional means of stereotaxy, the authors elected to use a personalized stereotactic platform. Immediate postoperative imaging captured complete laser ablation of the tumor, with long-term imaging demonstrating a decreased tumor size.

LESSONS

Individualized stereotactic platforms are increasingly used in adult populations, but pediatric use continues to be infrequent. In this report, the authors present the youngest reported case using a personalized stereotactic platform and show the effectiveness of this system for performing LITT in the youngest of populations with very thin skulls.

ABBREVIATIONS

CT = computed tomography; LITT = laser interstitial thermal therapy; MRI = magnetic resonance imaging

Ependymoma is the third most common brain tumor in pediatric populations and represents approximately 5% of all pediatric brain tumors.1 It originates from ependymocytes that line the ventricular system of the brain.2 Ninety percent of cases are located intracranially, with one-third situated supratentorially and two-thirds located within the posterior fossa.3 Symptom presentation is dependent on tumor location and can include headaches, seizures, nausea, vomiting, and ataxia.4 The incidence rate in pediatric populations is estimated at 0.24 per 100,000 children.2 The 5-year overall survival rate for pediatric cases is 58% to 66%. Tumors that occur between ages 0 and 4 have a 5-year survival rate of 42% to 53%.5

Historically, treatment for ependymoma has been maximal safe resection followed by radiation therapy.6 The extent of tumor resection is the major predictor of progression-free survival, with a significant correlation between the amount of residual tumor remaining postoperatively and the duration of progression-free survival.7 The use of chemotherapy in treatment protocols to avoid radiation therapy, especially in young children, remains controversial because of mixed results.2,8–10 However, in the ongoing SIOP Ependymoma II (An International Clinical Program for the Diagnosis and Treatment of Children, Adolescents and Young Adults With Ependymoma) and the ACNS0831 (Phase III Randomized Trial of Post-Radiation Chemotherapy in Patients With Newly Diagnosed Ependymoma Ages 1 to 21 Years) trials, early results have indicated a potential benefit of adjunct chemotherapy.11,12

Laser interstitial thermal therapy (LITT) involves stereotactic placement of a laser catheter to ablate a lesion and offers a more minimally invasive approach to the treatment of tumors and epilepsy.13 The first reported use of LITT in treating a pediatric brain tumor occurred in 2011 with the ablation of a supratentorial primitive neuroectodermal tumor.14 Since then, LITT has been used in the management of ependymoma, hypothalamic hamartoma, medulloblastoma, pilocytic astrocytoma, and other brain tumors that present a potentially difficult resection.15–20

Individualized stereotactic platforms offer a unique approach for LITT in diverse patient populations. These platforms such as STarFix (FHC Inc.) are single-use, patient-specific stereotactic frames and have been shown to have an accuracy similar to that of a traditional stereotactic frame.21 In this platform, bone anchors are placed several days prior to ablation and serve as artificial landmarks in the planning and design of the patient-specific frame and as attachment points of the frame during the LITT procedure. Although individualized stereotactic platforms are increasingly being used in adult populations, their usage in pediatric populations is still in the early stages. In this report, we document the youngest reported case of a personalized stereotactic platform used in the treatment of a supratentorial ependymoma in a pediatric patient.

Illustrative Case

A 2-year-old female had a known history of supratentorial ependymoma with multiple resections, ventriculoperitoneal shunt placement, seizures, adrenal insufficiency, hypotonia, and moderate intellectual disability. When she was 6 months old, at an outside facility in Japan, a supratentorial RELA-positive ependymoma was initially diagnosed in the frontal and parietal lobes bilaterally with infiltration of both lateral ventricles. At that time, she underwent a left frontoparietal craniotomy with excision of approximately half the tumor. Histology showed perivascular anucleate zones and readily apparent mitotic activity. Vascular endothelial proliferation and areas of necrosis were also present, and tumor cells were infiltrating adjacent brain parenchyma. One month later, the patient underwent a second left frontoparietal craniotomy for further tumor excision. At 9 months old, she underwent a right frontoparietal craniotomy for excision of a portion of the right side of the tumor. At 11 months old, she underwent a second right frontoparietal craniotomy for excision of the intraventricular and left posterior sections of the tumor. At 13 months of age, a right subdural peritoneum shunt was placed. She underwent shunt replacement 11 months later.

We began caring for the patient at our institution when she was 24 months of age. A tumor-associated cyst with entrapment had developed, and she underwent her fifth craniotomy for endoscopic cyst fenestration, further tumor excision, and placement of an external ventricular drain. At her 4-month postoperative follow-up, recent magnetic resonance imaging (MRI) demonstrated an enlarging, complex, enhancing mass in the right occipital region measuring 1.7 cm × 3.2 cm (Fig. 1A). There were additional enhancing masses along the posterior aspect of the midline ventricular system, left frontal horn, and left lateral ventricular margin and at the periphery of the left parietal lobe. She had been receiving chemotherapy to treat the tumor per the ACNS0831 repeat induction cycle A but had stopped chemotherapy 3 weeks prior to her follow-up appointment. The occipital lesion necessitated treatment, because it was enlarging on serial imaging despite systemic treatment. LITT was determined to be optimal treatment of this lesion for a few reasons. The patient had numerous scalp incisions, making wound healing a concern if a craniotomy were to be pursued. In addition, given the tumor’s location deep in the occipital lobe, LITT offered a means for treating the tumor without much disruption of surrounding tissue. Moreover, given her poor prognosis with her multiple recurrent tumors, fast recovery and return to home was important to the family.

FIG. 1
FIG. 1

Axial T1-weighted MRI. A: Preoperative image showing a right occipital lesion of heterogeneous intensity measuring 1.7 cm × 3.2 cm with surrounding edema. Stable ventricular anatomy and a left thalamic lesion are also present. B: Image obtained 24 hours post-LITT, confirming ablation of the occipital mass and showing expected surrounding edema. C: Image obtained 71 days post-LITT procedure, demonstrating decrease in occipital mass size and surrounding edema.

Given the patient’s extremely thin bone (approximately 2-mm thickness), there was concern that a conventional laser ablation bolt would not be able to hold the bone well. Therefore, a personalized stereotactic platform was selected and prepared for this case. The patient underwent bone fiducial placement prior to LITT ablation. While she was under general anesthesia, an estimate of the laser probe entry site was marked and the sites of the four bone fiducials were planned and marked, with each being at least 5 cm from the entry site. Small stab incisions were made over the marked areas, and the 4-mm screw was placed in the bone. The bone fiducials were then covered with scalp tissue, and the incisions were closed. Computed tomography (CT) of the head was performed immediately thereafter for platform planning and creation (Fig. 2A and B). She was discharged home the same day.

FIG. 2
FIG. 2

Anteroposterior (A) and lateral (B) views of the preoperative planning software (microtargeting WayPoint Planner 3.0) utilizing CT studies of the head obtained immediately after bone fiducial placement to generate an individualized stereotactic frame for the desired LITT trajectory. Intraoperative photographs showing placement of the three bone fiducials (C) and the three-dimensional (3D)-printed individualized stereotactic frame attached to the skull (D).

Five days later, the patient returned for LITT ablation of the right occipital lesion. She was positioned prone, and the individualized platform was affixed onto three of the four bone fiducials, as one had become loose (Fig. 2C and D). The area of entry was opened with a 15-blade scalpel, and a small burr hole was created. The laser probe was implanted in the usual fashion to the preoperatively planned distance. Marks were also made every 5 mm deeper from the point for the subsequent pullbacks that would be performed manually.

The patient was taken to the intraoperative MRI scanner for ablation. T2-weighted MRI was performed to confirm accurate placement of the probe within the lesion and the absence of hemorrhage. Laser ablation was then performed in a standard fashion. After ablation, the individualized platform was removed along with the bone fiducials, and the incision was closed in the usual fashion. The patient was transferred to the pediatric intensive care unit for close neurological assessments and was given a 6-day course of intravenous steroids to prevent postoperative cerebral edema. On postoperative day 1, another MRI scan was obtained, confirming complete ablation of the occipital mass with expected surrounding edema (Fig. 1B).

The patient was discharged 21 days postoperatively, because her hospital stay was complicated by some of her comorbid conditions including adrenal insufficiency, hyponatremia, and seizures; however, this was unrelated to the LITT procedure. The patient followed up 3 months later, with MRI demonstrating a decrease in both mass size and surrounding edema of the right occipital lesion (Fig. 1C). Two months post-LITT, she underwent a repeat open craniotomy to remove the recurrent midline tumor. Ultimately, 10 months post-LITT, a recurrence of all her tumors was noted including the LITT-treated area, and she was placed under hospice care until she died at 3.5 years of age.

Patient Informed Consent

The necessary patient informed consent was obtained in this study.

Discussion

Observations

LITT is a recent advancement in the treatment of pediatric brain tumors. In pediatric populations, its primary application has been for the treatment of epilepsy, which accounts for more than 80% of cases, whereas tumor treatment constitutes approximately 16% of its pediatric usage.18 Despite its relatively new application in pediatric brain tumors, LITT has been used successfully in the treatment of astrocytoma, oligodendroglioma, atypical teratoid rhabdoid tumor, supratentorial primitive neuroectodermal tumor, ganglioma, medulloblastoma, ependymoma, and optic glioma.18

The use of an individualized stereotactic platform for guidance of the laser probe in LITT ablation of a supratentorial ependymoma has not, to our knowledge, been previously reported in a patient this young. We demonstrate the advantage of using this system for LITT procedures in pediatric populations with thin skulls. In our case, probe placement was accomplished with desirable accuracy and without morbidity. One of the four fiducial posts did become loose between the initial placement and the LITT ablation procedure 5 days later. This event occurred because of the extreme thinness of the skull. However, we were able to affix the frame on the three remaining fiducials and proceed with the procedure without further difficulty. This illustrates an important consideration in selecting a three- versus four-legged frame, because a four-legged frame provides some flexibility in the event a fiducial post is not salvageable.

Personalized stereotactic frames, such as the STarFix platform, are frequently used for deep brain stimulation lead placement and stereoelectroencephalography.22–24 In pediatric LITT procedures, there are several reasons an individualized stereotactic platform may be preferable to traditional stereotactic frames or platforms such as the ROSA robot (Zimmer Biomet). To utilize the ROSA robot or the Vertek arm (Medtronic), one must place a trajectory guidance bolt for targeting of the laser probe. This requires an adequately thick skull to maintain a solid grip by the targeting bolt for the procedure. In small pediatric patients, this is not always reasonable, as their skulls can be extremely thin. By dispersing the force and using the smaller fiducials of the individualized platform, we can offer LITT to smaller pediatric patients. Although the Navigus system has been previously described for LITT in an infant using the Visulase system,25 this platform is more robust and capable of holding onto the heavier NeuroBlate (Monteris) robotic probe drive. A similar use of the NeuroBlate LITT system has been documented in a 6-month-old patient with the AXiiiS (Monteris) stereotactic miniframe system for the treatment of tuberous sclerosis.26 During ablation, an individualized stereotactic platform allows the surgeon to follow the preplanned trajectory precisely and accurately achieve the desired probe depth. In pediatric populations, 9% of all reported complications of LITT procedures consist of incorrect catheter placement.18 Personalized stereotactic platforms present a potential method of decreasing the occurrence of this technical complication, although this requires further studies to compare these complications to other means of performing LITT.

Personalized stereotactic platforms do have some limitations to consider when deciding on the optimal treatment for these patients, some of which we experienced in our case. This includes the need for the preoperative placement of bone fiducials and two separate operations, which expose the patient to anesthesia risk within a short time span. There is some concern that the cost of using personalized stereotactic platforms and the associated navigation software is more cumbersome than other means of performing LITT, although a formal financial comparison has yet to be documented.

Lessons

We describe the use of an individualized stereotactic platform in the treatment of supratentorial ependymoma in a pediatric patient with a very thin skull for which other options of stereotaxy were not feasible. Despite complex comorbidities, the patient recovered well from the procedure. This approach is another means of treating pediatric patients with supratentorial ependymoma, especially in patients with thin skulls.

Author Contributions

Conception and design: Salehi, Pistone, Klugh. Acquisition of data: Salehi, Lau, Pistone. Analysis and interpretation of data: Salehi, Lau. Drafting the article: Lau, Menousek, Pistone. Critically revising the article: all authors. Reviewed submitted version of manuscript: all authors. Approved the final version of the manuscript on behalf of all authors: Salehi. Statistical analysis: Lau. Administrative/technical/material support: Lau, Klugh.

References

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    Merchant TE, Li C, Xiong X, Kun LE, Boop FA, Sanford RA. Conformal radiotherapy after surgery for paediatric ependymoma: a prospective study. Lancet Oncol. 2009;10(3):258266.

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    • Search Google Scholar
    • Export Citation
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    Robertson PL, Zeltzer PM, Boyett JM, et al. Survival and prognostic factors following radiation therapy and chemotherapy for ependymomas in children: a report of the Children’s Cancer Group. J Neurosurg. 1998;88(4):695703.

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    Bouffet E, Tabori U, Huang A, Bartels U. Ependymoma: lessons from the past, prospects for the future. Childs Nerv Syst. 2009;25(11):13831385.

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    Grill J, Le Deley MC, Gambarelli D, et al. Postoperative chemotherapy without irradiation for ependymoma in children under 5 years of age: a multicenter trial of the French Society of Pediatric Oncology. J Clin Oncol. 2001;19(5):12881296.

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    • Search Google Scholar
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    Timmermann B, Kortmann RD, Kühl J, et al. Role of radiotherapy in anaplastic ependymoma in children under age of 3 years: results of the prospective German brain tumor trials HIT-SKK 87 and 92. Radiother Oncol. 2005;77(3):278285.

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    • Search Google Scholar
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    Smith A, Onar-Thomas A, Ellison DW, et al. EPEN-54. ACNS0831, phase III randomized trial of post-radiation chemotherapy in patients with newly diagnosed ependymoma ages 1 to 21 years. Neuro Oncol. 2020;22(suppl 3):iii318-iii319.

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    Jethwa PR, Lee JH, Assina R, Keller IA, Danish SF. Treatment of a supratentorial primitive neuroectodermal tumor using magnetic resonance-guided laser-induced thermal therapy. J Neurosurg Pediatr. 2011;8(5):468475.

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    Candela-Cantó S, Muchart J, Ramírez-Camacho A, et al. Robot-assisted, real-time, MRI-guided laser interstitial thermal therapy for pediatric patients with hypothalamic hamartoma: surgical technique, pitfalls, and initial results. J Neurosurg Pediatr. 2022;29(6):681692.

    • PubMed
    • Search Google Scholar
    • Export Citation
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    Zeller S, Kaye J, Jumah F, et al. Current applications and safety profile of laser interstitial thermal therapy in the pediatric population: a systematic review of the literature. J Neurosurg Pediatr. Published online July 2, 2021. doi:10.3171/2021.2.PEDS20721

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    Salehi A, Kamath AA, Leuthardt EC, Kim AH. Management of intracranial metastatic disease with laser interstitial thermal therapy. Front Oncol. 2018;8:499.

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    Cross KA, Salehi A, Abdelbaki MS, Gutmann DH, Limbrick DD Jr. MRI-guided laser interstitial thermal therapy for deep-seated gliomas in children with neurofibromatosis type 1: report of two cases. Childs Nerv Syst. 2023;39(3):787791.

    • PubMed
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    • Export Citation
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    Matzke C, Lindner D, Schwarz J, et al. A comparison of two surgical approaches in functional neurosurgery: individualized versus conventional stereotactic frames. Comput Aided Surg. 2015;20(1):3440.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22

    Hodge JO, Cook P, Brandmeir NJ. Awake deep brain stimulation surgery without intraoperative imaging is accurate and effective: a case series. Oper Neurosurg (Hagerstown). 2022;23(2):133138.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23

    Dadey DY, Kamath AA, Smyth MD, Chicoine MR, Leuthardt EC, Kim AH. Utilizing personalized stereotactic frames for laser interstitial thermal ablation of posterior fossa and mesiotemporal brain lesions: a single-institution series. Neurosurg Focus. 2016;41(4):E4.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24

    Pistol C, Daneasa A, Ciurea J, et al. Accuracy and safety of customized stereotactic fixtures for stereoelectroencephalography in pediatric patients. Stereotact Funct Neurosurg. 2021;99(1):1724.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25

    Lee JJ, Clarke D, Hoverson E, Tyler-Kabara EC, Ho WS. MRI-guided laser interstitial thermal therapy using the Visualase system and Navigus frameless stereotaxy in an infant: technical case report.J Neurosurg Pediatr. 2021;28(1):5053.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26

    Hooten KG, Werner K, Mikati MA, Muh CR. MRI-guided laser interstitial thermal therapy in an infant with tuberous sclerosis: technical case report. J Neurosurg Pediatr. 2018;23(1):9297.

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  • Collapse
  • Expand
  • FIG. 1

    Axial T1-weighted MRI. A: Preoperative image showing a right occipital lesion of heterogeneous intensity measuring 1.7 cm × 3.2 cm with surrounding edema. Stable ventricular anatomy and a left thalamic lesion are also present. B: Image obtained 24 hours post-LITT, confirming ablation of the occipital mass and showing expected surrounding edema. C: Image obtained 71 days post-LITT procedure, demonstrating decrease in occipital mass size and surrounding edema.

  • FIG. 2

    Anteroposterior (A) and lateral (B) views of the preoperative planning software (microtargeting WayPoint Planner 3.0) utilizing CT studies of the head obtained immediately after bone fiducial placement to generate an individualized stereotactic frame for the desired LITT trajectory. Intraoperative photographs showing placement of the three bone fiducials (C) and the three-dimensional (3D)-printed individualized stereotactic frame attached to the skull (D).

  • 1

    Ostrom QT, Cioffi G, Gittleman H, et al. CBTRUS Statistical Report: primary brain and other central nervous system tumors diagnosed in the United States in 2012-2016. Neuro Oncol. 2019;21(suppl 5):v1-v100.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2

    Vitanza NA, Partap S. Pediatric ependymoma. J Child Neurol. 2016;31(12):13541366.

  • 3

    Kilday JP, Rahman R, Dyer S, et al. Pediatric ependymoma: biological perspectives. Mol Cancer Res. 2009;7(6):765786.

  • 4

    Malbari F. Pediatric Neuro-Oncology. Neurol Clin. 2021;39(3):829845.

  • 5

    Gatta G, Botta L, Rossi S, et al. Childhood cancer survival in Europe 1999-2007: results of EUROCARE-5--a population-based study. Lancet Oncol. 2014;15(1):3547.

  • 6

    Merchant TE, Li C, Xiong X, Kun LE, Boop FA, Sanford RA. Conformal radiotherapy after surgery for paediatric ependymoma: a prospective study. Lancet Oncol. 2009;10(3):258266.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    Robertson PL, Zeltzer PM, Boyett JM, et al. Survival and prognostic factors following radiation therapy and chemotherapy for ependymomas in children: a report of the Children’s Cancer Group. J Neurosurg. 1998;88(4):695703.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    Bouffet E, Tabori U, Huang A, Bartels U. Ependymoma: lessons from the past, prospects for the future. Childs Nerv Syst. 2009;25(11):13831385.

  • 9

    Grill J, Le Deley MC, Gambarelli D, et al. Postoperative chemotherapy without irradiation for ependymoma in children under 5 years of age: a multicenter trial of the French Society of Pediatric Oncology. J Clin Oncol. 2001;19(5):12881296.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Timmermann B, Kortmann RD, Kühl J, et al. Role of radiotherapy in anaplastic ependymoma in children under age of 3 years: results of the prospective German brain tumor trials HIT-SKK 87 and 92. Radiother Oncol. 2005;77(3):278285.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Leblond P, Massimino M, English M, et al. Toward improved diagnosis accuracy and treatment of children, adolescents, and young adults with ependymoma: the International SIOP Ependymoma II Protocol. Front Neurol. 2022;13:887544.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    Smith A, Onar-Thomas A, Ellison DW, et al. EPEN-54. ACNS0831, phase III randomized trial of post-radiation chemotherapy in patients with newly diagnosed ependymoma ages 1 to 21 years. Neuro Oncol. 2020;22(suppl 3):iii318-iii319.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    Kulubya ES, Kercher MJ, Phillips HW, Antony R, Edwards MSB. Advances in the Treatment of Pediatric Brain Tumors. Children (Basel). 2022;10(1):62.

  • 14

    Jethwa PR, Lee JH, Assina R, Keller IA, Danish SF. Treatment of a supratentorial primitive neuroectodermal tumor using magnetic resonance-guided laser-induced thermal therapy. J Neurosurg Pediatr. 2011;8(5):468475.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15

    Candela-Cantó S, Muchart J, Ramírez-Camacho A, et al. Robot-assisted, real-time, MRI-guided laser interstitial thermal therapy for pediatric patients with hypothalamic hamartoma: surgical technique, pitfalls, and initial results. J Neurosurg Pediatr. 2022;29(6):681692.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16

    Riordan M, Tovar-Spinoza Z. Laser induced thermal therapy (LITT) for pediatric brain tumors: case-based review. Transl Pediatr. 2014;3(3):229235.

  • 17

    Baker C, Crevelt J, Whipple N, Bollo RJ, Cheshier S. Treatment of a symptomatic thalamic pilocytic astrocytoma with reservoir placement and laser interstitial thermal therapy: illustrative case. J Neurosurg Case Lessons. 2022;3(11):CASE21363.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18

    Zeller S, Kaye J, Jumah F, et al. Current applications and safety profile of laser interstitial thermal therapy in the pediatric population: a systematic review of the literature. J Neurosurg Pediatr. Published online July 2, 2021. doi:10.3171/2021.2.PEDS20721

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19

    Salehi A, Kamath AA, Leuthardt EC, Kim AH. Management of intracranial metastatic disease with laser interstitial thermal therapy. Front Oncol. 2018;8:499.

  • 20

    Cross KA, Salehi A, Abdelbaki MS, Gutmann DH, Limbrick DD Jr. MRI-guided laser interstitial thermal therapy for deep-seated gliomas in children with neurofibromatosis type 1: report of two cases. Childs Nerv Syst. 2023;39(3):787791.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21

    Matzke C, Lindner D, Schwarz J, et al. A comparison of two surgical approaches in functional neurosurgery: individualized versus conventional stereotactic frames. Comput Aided Surg. 2015;20(1):3440.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22

    Hodge JO, Cook P, Brandmeir NJ. Awake deep brain stimulation surgery without intraoperative imaging is accurate and effective: a case series. Oper Neurosurg (Hagerstown). 2022;23(2):133138.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23

    Dadey DY, Kamath AA, Smyth MD, Chicoine MR, Leuthardt EC, Kim AH. Utilizing personalized stereotactic frames for laser interstitial thermal ablation of posterior fossa and mesiotemporal brain lesions: a single-institution series. Neurosurg Focus. 2016;41(4):E4.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24

    Pistol C, Daneasa A, Ciurea J, et al. Accuracy and safety of customized stereotactic fixtures for stereoelectroencephalography in pediatric patients. Stereotact Funct Neurosurg. 2021;99(1):1724.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25

    Lee JJ, Clarke D, Hoverson E, Tyler-Kabara EC, Ho WS. MRI-guided laser interstitial thermal therapy using the Visualase system and Navigus frameless stereotaxy in an infant: technical case report.J Neurosurg Pediatr. 2021;28(1):5053.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26

    Hooten KG, Werner K, Mikati MA, Muh CR. MRI-guided laser interstitial thermal therapy in an infant with tuberous sclerosis: technical case report. J Neurosurg Pediatr. 2018;23(1):9297.

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