Laser interstitial thermal therapy for intracranial dural-based lesions: A single center case series of 20 patients

Laser interstitial thermal therapy (LITT) is a minimally invasive alternative to craniotomy for intracranial lesions in patients who are poor surgical candidates, but its role in treating dural-based lesions remains underexplored. This study evaluates the safety and feasibility of LITT for dural-based lesions.

We retrospectively reviewed 431 LITT cases at our institution and identified 20 patients who underwent LITT for 22 dural-based lesions (two patients received double LITT for two separate lesions). Primary outcomes included postoperative complications, neurologic deficits, extent of ablation (EOA), and readmission. Secondary outcomes included progression-free survival (PFS) and overall survival (OS). Subgroup analysis was performed by pathology type (meningioma vs metastasis).

Among 20 patients (mean age: 67 years), meningiomas (50%, n = 10) and metastases (35%, n = 7) were the most common pathologies. Most lesions (85%) were recurrent; 50% of patients had multifocal disease. Two patients underwent dual-lesion ablation with separate trajectories during the same surgery. Median lesion volume was 4.5 cm³ (IQR 6.5); mean EOA was 119.2% (SD 37.9%). EOA was similar for metastases (127.3%, n = 8) and meningiomas (102.9%, n = 11; p = 0.155), despite significantly different volumes (2.7 cm³ vs. 6.9 cm³; p = 0.015). One patient experienced transient neurological deficit postoperative, however there were no neurosurgical readmissions. Recurrence occurred in 11 patients (55%; mean PFS: 524 days). OS for overall cohort was 707 days but differed significantly between pathology groups (p = 0.012).

LITT appears safe and feasible for treating dural-based lesions in select patients. Despite technical challenges, outcomes support further investigation into LITT's long term efficacy and optimization of ablation parameters.