Learning Curve Analysis and Adverse Events After Implementation of Neurosurgical Laser Ablation Treatment: A Population-Based Single-Institution Consecutive Series

Margret Jensdottir; Ulrika Sandvik; Asgeir S Jakola; Michael Fagerlund; Annika Kits; Klara Guðmundsdóttir; Sara Tabari; Tomas Majing; Alexander Fletcher-Sandersjöö; Clark C Chen; Jiri Bartek Jr

doi:10.1016/j.nec.2022.12.003

Learning Curve Analysis and Adverse Events After Implementation of Neurosurgical Laser Ablation Treatment: A Population-Based Single-Institution Consecutive Series

Neurosurg Clin N Am. 2023 Apr;34(2):259-267. doi: 10.1016/j.nec.2022.12.003.

Affiliations

¹ Department of Clinical Neuroscience, Section for Neurosurgery, Karolinska Institutet, Stockholm, Sweden; Department of Neurosurgery, Karolinska University Hospital, Hotellet Plan 4, 171 76 Stockholm, Sweden. Electronic address: margret.jensdottir@regionstockholm.se.
² Department of Clinical Neuroscience, Section for Neurosurgery, Karolinska Institutet, Stockholm, Sweden; Department of Neurosurgery, Karolinska University Hospital, Hotellet Plan 4, 171 76 Stockholm, Sweden.
³ Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg, Sweden; Department of Neurosurgery, Sahlgrenska University Hospital, Blå stråket 7, plan 3, Sahlgrenska Universitetssjukhuset, 41345 Gothenburg, Sweden.
⁴ Department of Neuroradiology, Karolinska University Hospital, ME Neuroradiologi, 171 76 Stockholm, Sweden.
⁵ Department of Neuroradiology, Karolinska University Hospital, ME Neuroradiologi, 171 76 Stockholm, Sweden; Department of Clinical Neuroscience, Karolinska Institutet.
⁶ Funktionsenhet Neuro Operation, Perioperativ Medicin och Intensivvård (PMI), Karolinska Universitetssjukhuset Solna, 171 76 Stockholm Sweden.
⁷ Department Chair, Neurosurgery, University of Minnesota Medical School, D429 Mayo Memorial Building, 420 Delaware St. S. E., MMC96, Minneapolis, MN 55455, USA.
⁸ Department of Clinical Neuroscience, Section for Neurosurgery, Karolinska Institutet, Stockholm, Sweden; Department of Neurosurgery, Karolinska University Hospital, Hotellet Plan 4, 171 76 Stockholm, Sweden; Department of Neurosurgery, Rigshospitalet, Copenhagen, Denmark.

PMID: 36906332
DOI: 10.1016/j.nec.2022.12.003

Abstract

Objective and methods: We conducted a retrospective review of the first 30 patients treated with stereotactic laser ablation (SLA) at our institution since the introduction of the technique in September 2019. We aimed to analyze our initial results and potential learning curve by investigating precision and lesion coverage and assessing the frequency and nature of adverse events according to the Landriel-Ibanez classification for neurosurgical complications.

Results: Indications were de novo gliomas (23%), recurrent gliomas (57%), and epileptogenic foci (20%). There was a trend toward improvement of lesion coverage and target deviation, and a statistically significant improvement in entry point deviation, over time. Four patients (13.3%) experienced a new neurological deficit, where three patients had transient and one patient had permanent deficits, respectively. Our results show a learning curve on precision measures over the first 30 cases. Based on our results the technique can safely be implemented at centers with experience in stereotaxy.

Keywords: Complications; Landriel–Ibanez classification; Laser interstitial thermal therapy; Learning curve; Neurosurgery; Stereotactic laser ablation.

Publication types

Review

MeSH terms

Brain Neoplasms* / surgery
Glioma* / surgery
Humans
Laser Therapy* / methods
Learning Curve
Magnetic Resonance Imaging
Stereotaxic Techniques