“I’m proud to be a part of a place where we can offer patients every possible treatment for brain tumors,” says neurosurgeon Kalil Abdullah, MD, MSc.

Dr. Abdullah, UPMC Shadyside surgeon and the director of Translational Neuro-Oncology at UPMC Hillman Cancer Center, is discussing the newest of these treatments introduced at Shadyside: MRI-guided laser interstitial thermal therapy, or LITT. It involves the destruction of a lesion or tissue using heat from a laser.

“LITT is a very exciting and relatively new treatment for brain tumors,” Dr. Abdullah says. “It’s a less invasive approach for tumors that are very deep in the brain or for tumors that were previously considered to be inoperable. It involves placing a probe less than the diameter of a pencil into the brain using a very small incision that is less than an inch long. And then the patient has a small robot attached to their skull, which allows us to use MRI [magnetic resonance imaging] to guide the laser. We can see in real time the tumor being burned from the inside out.

“LITT really expands our ability to treat cancer and the progression of cancer in the brain. And because the treatment is minimally invasive, most patients are back home the next day after surgery.”

LITT demonstrates UPMC Shadyside’s commitment to growing state-of-the-art neurosurgery. “An institution’s ability to offer LITT depends on both advanced technology and the collaboration of experts in multiple disciplines,” Dr. Abdullah states.

“For example, LITT would not be possible for us to do without Brainlab, the integrated software and hardware system that has revolutionized how we combine preoperative imaging information and surgery.” Brainlab came to the hospital at the urging of Shadyside neurosurgeon Pascal Zinn, MD, PhD, director of the adult neurosurgical oncology program at the University of Pittsburgh.1

“Then on top of that, we need to have coordination between our anesthesia team, our radiology and surgical teams, and our MRI team.”

“A new feather in our cap”

“I cannot commend Dr. Abdullah enough for bringing this LITT technology to Shadyside,” says Shiv Goel, MD, chief of the Division of Anesthesiology. “I think it adds a new feather in our cap that we are able to provide such a high-tech, sophisticated procedure for patients. Before, we had to send patients out of the state for treatment.”

When Dr. Goel learned that Dr. Abdullah wanted to develop the innovative LITT program, he encouraged Kitty Zell, vice president of Operations, to help facilitate the needed multidisciplinary coordination. “She was right on it in her usual style,” he remembers. “Everybody got on the team very quickly.”

“We introduced a new surgical workflow and a new technique across multiple departments with surprising speed,” Dr. Abdullah points out. “Everybody has 
 been wonderful.”

“Getting this going has been a really great team effort,” agrees Christine Peabody, MSN, RN, CNOR, the unit director of UPMC Shadyside’s operating rooms. “Our OR staff has been amazing.”

“It’s a multidisciplinary approach with the other departments in the hospital to make sure these patients’ procedures are done correctly,” says Karen Svorcek, RN, BSN, CNOR, who has been an OR nurse for 22 years. “We usually spend about an hour or two in the operating room. The patient then goes down to the MRI and returns to the OR, where we remove the device. Dr. Abdullah has been excellent in going through the process for us. We feel confident about our roles.”

Dr. Goel and his team are responsible for anesthetizing the patient in the operating room so that Dr. Abdullah can place the probe in the right spot in the brain, under imaging guidance. “Once that bolt is placed,” Dr. Goel says, “it has to stay in the precise location as we transport the patient safely through the hospital to the MRI, making sure that neither the device nor the breathing tube gets dislodged.

“We had good support from my entire department,” Dr. Goel says proudly, “especially from our very committed and very senior certified registered nurse anesthetists [CRNAs]. A lot of them were more than happy to help us develop the best ways of caring for patients during this process.

“I’m interested in Shadyside’s long and unique history,” Dr. Goel adds. “Today, as we become UPMC’s premier cancer surgery center, I think this is new history in the making.”

The role of MRI

MRI is essential to the LITT procedure. It allows surgeons not only to identify the tumor and plan the trajectory for the laser probe but also to quantify heat deposition within and around the target area during the destruction of the lesion. This temperature monitoring enables surgeons to assess the death of cancer cells in real time and to prevent damage to surrounding tissue.

“LITT is a tremendous collaborative effort among multiple departments,” says Vikas Agarwal, MD, chief of UPMC’s Division of Neuroradiology. “I think we’re recognizing that the best way to take care of patients is collaboratively. When experts from all domains bring that expertise to the table, patients benefit.

“It’s interesting that radiology is getting as specialized as other medical fields,” Dr. Agarwal says. “We evolve with our clinical colleagues, so as neurosurgery gets more sub-specialized and much more intricate, then the imaging has to go along with it. As I tell our trainees, you can’t have the world’s best neurosurgical department without a comparable neuroradiology department.”

Dr. Agarwal explains that while the patient is in the MRI suite, the surgeon can visualize, second by second, exactly where the pathway of heat is going in the brain. “That allows us to determine how much heat to give the tumor and where the laser should point,” Dr. Abdullah says. “And the robot actually enables us to control the laser from inside the MRI scanner. The robot allows us to rotate, advance, and aim our laser in different areas.”

At the same time, says Dr. Agarwal, “Our radiologists are just down the hall reading the scans as they’re being done. If there would be a potential complication, we can communicate that with the surgeon very quickly.”

Pride in innovation

Everybody who is part of developing this new LITT program seems proud to be able to offer it to brain tumor patients. Jenilynn Porter, RT, BA, MHA, director of Imaging Services at UPMC Shadyside and Hillman Cancer Center, says that “my staff and I are so happy to collaborate on this new innovation for the patients. My staff that actually do the MRI imaging are very intrigued by everything. They wanted to learn this. They wanted to understand it and be part of it.

“My lead MRI technologist, Susan Massey, MR, ARRT, had extensive training to understand the LITT procedures and to make sure that we have the correct protocols.

“We have a wonderful team with the physicians, the anesthesiologists, and the nurses,” says Ms. Porter, who oversees MRI, Interventional Radiology, Nuclear Medicine, Ultrasound, Diagnostic, PET, and CT.

“I’m a lifelong Pittsburgher,” she adds. “From Plum. When I see all the ways we can help people today at Shadyside, I can hardly believe it.”

In less than a year, in fact, UPMC Shadyside has already become the highest-volume site for laser ablation of brain tumors in the state of Pennsylvania.

“Being diagnosed with a brain tumor is a life-changing event,” Dr. Abdullah says. “But once that diagnosis is there, here in Pittsburgh we are proud to have the facilities and resources of UPMC right in our back yard. There’s a reason why people come here from all over the world for treatment. I find it a hopeful and exciting time to live and work in this environment.”

1. For more about Brainlab and Dr. Zinn, please see “Mapping the Miracle Organ” in the Winter 2022–2023 VOICE of UPMC Shadyside. For a copy, call the Shadyside Hospital Foundation at 412-623-6600 or visit shadysidehospitalfoundation.org.