Blood-brain barrier disruption following MR-guided laser interstitial thermal therapy

BACKGROUND: MR-guided laser interstitial thermal therapy (LITT) is a minimally invasive neurosurgical treatment used for managing brain tumors and drug-resistant epilepsy. This study investigates the temporal pattern of blood-brain barrier (BBB) permeability following LITT in patients with tumors and epilepsy.

METHODS: Twenty-three patients undergoing LITT (11 with brain tumors, 12 with non-tumor epilepsy) were enrolled. Dynamic Contrast-Enhanced Magnetic Resonance Imaging (DCE-MRI) and blood levels of glial fibrillary acidic protein (GFAP) were used to assess BBB permeability one day before and on days 1, 15, 30, and 45 post-LITT.

RESULTS: Quantitative analysis using DCE-MRI demonstrated significant increases in perilesional BBB permeability on days 15, 30, and 45 postoperatively (P < .005), with no notable changes on the first postoperative day. The findings were robust with regards to region of interest selection, showing consistent increases in BBB permeability in patients with both brain tumors and epilepsy. Additionally, GFAP levels peaked significantly above baseline on the first postoperative day, maintaining elevated levels through day 45.

CONCLUSIONS: Quantitative DCE-MRI and GFAP blood levels demonstrate a prolonged window of increased perilesional BBB permeability following LITT, potentially enhancing the delivery and efficacy of therapeutic agents in patients with brain tumors.