Laser interstitial thermal therapy for hemorrhagic subcortical cavernous malformations: patient series

BACKGROUND: Subcortical cavernous malformations (CMs) that have bled pose increased risk of repeat hemorrhage and symptomatic progression. Open resection can be curative, but accessing CMs in certain subcortical locations poses significant risk of procedural morbidity. This study assesses the safety and feasibility of MRI-guided laser interstitial thermal therapy (MRgLITT) for hemorrhagic subcortical CMs. OBSERVATIONS: The authors retrospectively reviewed the medical records of patients who underwent MRgLITT of a subcortical CM with prior symptomatic hemorrhage at their center. Seven patients underwent MRgLITT of subcortical CMs with at least 1 prior symptomatic hemorrhage. There were no symptomatic or radiographic hemorrhages perioperatively or in the follow-up period (mean 26.6 months, range 12-53 months). All patients were discharged home on postoperative day 1 (n = 5) or 2 (n = 2). Three patients had transient (< 30 days) neurological deficits. Compared to preoperative baseline, as of the last follow-up, 5 patients had improvement of neurological symptoms, 1 was stable 8 months after surgery, and 1 remained asymptomatic. There was a significant decrease in CM volumes on both T1-weighted (p = 0.016) and T2-weighted (p = 0.016) sequences. LESSONS: MRgLITT is a promising treatment for subcortical, hemorrhagic CMs, offering a minimally invasive approach with low morbidity and favorable clinical outcomes in this preliminary series. https://thejns.org/doi/10.3171/CASE25845.