Bilateral Lumbar Radiculopathy Secondary to Myxopapillary Ependymoma: A Case Report.

Objective: The purpose of this case report is to describe the presentation of a patient with bilateral lumbar radiculopathy secondary to myxopapillary ependymoma. Clinical Features: A 45-year-old man presented to a chiropractic office for evaluation and treatment of chronic lower back pain with bilateral lower extremity radiation. The initial onset of pain was related to a lifting injury 6 years prior that never fully resolved. Over the year before presentation, the symptomatology intensified, as the patient's activities now included a 1.5-hour commute to and from work. Intervention and Outcome: In the interim of waiting for the magnetic resonance imaging (MRI) to be performed, chiropractic manual therapy was initiated using the Cox technique. The patient had 7 treatments, in which lumbar spine pain was reduced from 7 out of 10 to 5 out of 10 on a numeric pain scale and leg pain was reduced from 7 out of 10 to 0 out of 10. The patient obtained an MRI with contrast, which demonstrated a mass at the conus medullaris. An immediate consultation was made with a neurosurgeon. Surgical resection revealed a myxopapillary ependymoma. He was then followed up with by the neurosurgeon at 3 months and 1 year, with sustained improvements and no further symptoms. After surgery, the patient did well without complications. Conclusion: A patient with an intradural mass at the level of the conus medullaris presented for chiropractic care and responded positively to treatment but had an underlying condition that was corrected with surgery. For this patient, MRI assisted with evaluation and early diagnosis, and surgical resection facilitated a beneficial outcome.

Laser interstitial thermal therapy for in-field recurrence of brain metastasis after stereotactic radiosurgery: does treatment with LITT prevent a neurologic death?

Brain metastasis (BM) affects up to one-third of adults with cancer and carries a historically bleak prognosis. Despite advances in stereotactic radiosurgery (SRS), rates of in-field recurrence (IFR) after SRS range from 10 to 25%. High rates of neurologic death have been reported after SRS failure, particularly for recurrences deep in the brain and surgically inaccessible. Laser interstitial thermal therapy (LITT) is an emerging option in this setting, but its ability to prevent a neurologic death is unknown. In this study, we investigate the causes of death among patients with BM who undergo LITT for IFR after SRS. We conducted a single institution retrospective case series of patients with BM who underwent LITT for IFR after SRS. Clinical and demographic data were collected via chart review. The primary endpoint was cause of death. Between 2010 and 2018, 70 patients with BM underwent LITT for IFR after SRS. Median follow-up after LITT was 12.0 months. At analysis, 49 patients died; a cause was determined in 44. Death was neurologic in 20 patients and non-neurologic in 24. The 24-month cumulative incidence of neurologic and non-neurologic death was 35.1% and 38.6%, respectively. Etiologies of neurologic death included local recurrence (n = 7), recovery failure (n = 7), distant progression (n = 5), and other (n = 1). Among our patient population, LITT provided the ability to stabilize neurologic disease in up to 2/3 of patients. For IFR after SRS, LITT may represent a reasonable treatment strategy for select patients. Additional work is necessary to determine the extent to which LITT can prevent neurologic death after recurrence of BM.

Laser Interstitial Thermal Therapy Technology, Physics of Magnetic Resonance Imaging Thermometry, and Technical Considerations for Proper Catheter Placement During Magnetic Resonance Imaging-Guided Laser Interstitial Thermal Therapy.

Laser-induced thermal therapy has become a powerful tool in the neurosurgical armamentarium. The physics of laser therapy are complex, but a sound understanding of this topic is clinically relevant, as many centers have incorporated it into their treatment algorithm, and educated patients are demanding consideration of its use for their disease. Laser ablation has been used for a wide array of intracranial lesions. Laser catheter placement is guided by stereotactic planning; however, as the procedure has popularized, the number of ways in which the catheter can be inserted has also increased. There are many technical nuances for laser placement, and, to date, there is not a clear understanding of whether any one technique is better than the other. In this review, we describe the basic physics of magnetic resonance-guided laser-induced thermal therapy and describe the several common techniques for accurate Visualase laser catheter placement in a stepwise fashion. ABBREVIATIONS: MRg-LITT, magnetic resonance-guided laser-induced thermal therapyPAD, precision aiming device.