Characterizing LITT vs Tubular Resection Pre and Post-operative Prognostic Factors for the Resection of Intra-axial Brain Neoplasms

Introduction: MRI-guided laser interstitial thermal therapy (LITT) and Vycor tubular retractors are designed to enhance tumor resection by minimizing intraoperative brain manipulation, preserving microvasculature, and improving hemostasis. Both approaches have shown favorable outcomes compared to open surgery. This study aims to compare pre- and post-operative prognostic factors between patients undergoing LITT or tubular resection.

Methods: An institutional retrospective review (2012–2020) of patients with GBM, metastases, or low-grade gliomas (LGG) was conducted. Patient demographics, tumor characteristics, and operative variables were analyzed using multiple linear regression (p < 0.05) on StataIC16.1.

Results: Of 76 patients, 55 were LITT and 21 were tubular. Overall, no significant differences were found in age, tumor laterality, length of stay, discharge disposition, complication rates, or 30-day readmission rates. However, there was a higher proportion of female patients who underwent transtubular resection than LITT, which had smaller lesions overall. Of the techniques, tumor location differed significantly between the two groups, with more parietal tumors in trans tubular resection patients and more frontal, subcortical, and temporal tumors in LITT patients. In addition, median PFS was not significantly different between the two groups overall or within specific subgroups. Comparatively, gender, pathology, and tumor size were identified as significant predictors for the success of LITT, with younger age, smaller tumor size, and female gender associated with improved survival outcomes in LITT patients.

Conclusion : While there is no significant difference in survival for minimally invasive tumor cytoreduction using LITT or tubular resection amongst the general patient population, select patient characteristics may predict improved survival with one method over the other. In the current study, younger age, smaller tumor size, and female sex were predictors of improved PFS with LITT compared to tubular retractors. The findings of this study may influence the decisions to pursue LITT versus transtubular resection for minimally invasive cytoreduction of intra-axial neoplasms.