Laser insterstitial thermal therapy followed by craniotomy for tumor resection for pediatric diffuse midline glioma: illustrative case

BACKGROUND: Resection of thalamic and other subcortical tumors has historically been associated with high morbidity and mortality. Laser interstitial thermal therapy (LITT) followed by craniotomy for resection of ablated tumor is a promising new combined technique. Here the authors describe the first application of this technique in a pediatric patient. OBSERVATIONS: A 6-year-old boy presented with 6 weeks of progressive right hemibody weakness and aphasia. Imaging demonstrated a 4.5-cm left basal ganglia/thalamic mass with moderate hydrocephalus. He underwent endoscopic third ventriculostomy with biopsy, which was positive for diffuse midline glioma. He subsequently received LITT with craniotomy for resection of ablated tumor, after which he remained at his neurological baseline and proceeded with adjuvant radiation therapy. LESSONS: This case study demonstrated the feasibility and safety of combined LITT with tumor resection, even in a pediatric patient, for debulking deep lesions that would be difficult to treat with either LITT or resection alone. However, intraoperatively the authors found that the post-LITT tissue had a firmer consistency than anticipated with poor borders, resulting in similar surgical complexity as resection of similar lesions without pre-resection LITT. https://thejns.org/doi/10.3171/CASE251030.