激光间质热疗法（LITT）因其能够有效地将精确的热能传递到病变部位而在外科神经肿瘤学中展现出前景。消融程度 (EOA) 是改善患者预后的一个预后因素，但通常受到病灶周围散热结构的影响，这可能导致不对称消融。本研究的目的是定量评估脑转移 LITT 中各种病灶周围散热器结构对 EOA 的影响。针对 22 名独特的脑转移患者进行的 27 次手术符合纳入标准。确定了颅内散热结构：脑沟、脑膜、脑脊液 (CSF) 空间和脉管系统。通过测量从沿激光导管的近端、中点和远端位置到双侧消融区域最远边缘的 3 对正交距离来确定不对称消融。还记录了激光导管上相同点到最近散热器的距离。创建散热器效应指数是为了作为不对称消融的代理。 Pearson 相关性、t 检验和方差分析是进行的统计分析。从导管中点开始，27 个散热器分别是脑膜 (40.7%)、脑沟 (22.2%)、脉管系统 (22.2%) 和脑脊液间隙 ( 14.8%）。在沿导管轨道的所有点上，对不对称消融存在显着的广义散热效应 (P < .0001)。观察到不对称消融与激光导管中点的 EOA 之间存在负相关性 (r = -0.445，P = .020)。与脑沟相比，脑脊液空间对不对称消融体积的影响更大 (P = .069)。这种新颖的定量分析表明病灶周围散热器有助于不对称消融。脑脊液空间趋向于更高程度的不对称消融。重要的是，如果散热器位于激光探头中点 13.3 毫米以内，神经外科医生可能会在术前预见到不对称消融。这些初步结果可能会指导 LITT 中转移性脑损伤的手术决策。版权所有 © 神经外科医生大会 2024。保留所有权利。

Laser interstitial thermal therapy (LITT) has demonstrated promise in surgical neuro-oncology because of its effectiveness in delivering precise thermal energy to lesions. The extent of ablation (EOA) is a prognostic factor in improving patient outcomes but is often affected by perilesional heatsink structures, which can lead to asymmetric ablations. The purpose of this study was to quantitatively evaluate the impact of various perilesional heatsink structures on the EOA in LITT for brain metastases.Twenty-seven procedures for 22 unique patients with brain metastases fit the inclusion criteria. Intracranial heatsink structures were identified: sulci, meninges, cerebrospinal fluid (CSF) spaces, and vasculature. Asymmetric ablation was determined by measuring 3 pairs of orthogonal distances from the proximal, midpoint, and distal locations along the laser catheter to the farthest edge of the ablation zone bilaterally. Distances from the same points on the laser catheter to the nearest heatsink were also recorded. The Heatsink Effect Index was created to serve as a proxy for asymmetric ablation. Pearson correlations, t-tests, and analysis of variance were the statistical analyses performed.From the midpoint of the catheter, the 27 heatsinks were meninges (40.7%), sulci (22.2%), vasculature (22.2%), and CSF spaces (14.8%). Across all points along the catheter track, there was a significant generalized heatsink effect on asymmetric ablations (P < .0001). There was a negative correlation observed between asymmetric ablations and EOA from the midpoint of the laser catheter (r = -0.445, P = .020). Compared with sulci, CSF spaces trended toward a greater effect on asymmetric ablation volumes (P = .069).This novel quantitative analysis shows that perilesional heatsinks contribute to asymmetric ablations. CSF spaces trended toward higher degrees of asymmetric ablations. Importantly, neurosurgeons may anticipate asymmetric ablations preoperatively if heatsinks are located within 13.3 mm of the laser probe midpoint. These preliminary results may guide surgical decision-making in LITT for metastatic brain lesions.Copyright © Congress of Neurological Surgeons 2024. All rights reserved.