Same-session hybrid surgery for multifocal glioblastoma: integrating open resection with laser interstitial thermal therapy. Illustrative cases

BACKGROUND: Multifocal glioblastoma (GBM) poses therapeutic challenges because spatially separated lesions typically require multiple craniotomies. Laser interstitial thermal therapy (LITT) offers a minimally invasive option for deep or eloquently located tumors, but is rarely integrated with open resection. This report describes a hybrid approach combining craniotomy and LITT to maximize cytoreduction while limiting operative burden. OBSERVATIONS: The authors present the cases of 2 patients with multifocal GBM, and case 1 represents, to their knowledge, the first reported same-session hybrid approach wherein both craniotomy for the left frontal lesion and LITT for the contralateral periventricular lesion were performed during a single operative session. Case 2 underwent staged hybrid treatment: initial craniotomy for the right parieto-occipital lesion, followed by LITT for the right mesial temporal lesion after pathological confirmation of isocitrate dehydrogenase-wildtype GBM. In case 1, the same-session approach achieved gross-total resection (GTR) of the frontal lesion and 93% extent of ablation (EOA) of the periventricular mass, with discharge on postoperative day 2. Case 2 achieved GTR of the right parieto-occipital lesion and 120% EOA of the temporal lesion, with discharge on postablation day 1. LESSONS: A hybrid approach combining resection and LITT can safely achieve extensive cytoreduction in multifocal GBM while avoiding multiple craniotomies. Same-session strategies eliminate repeat anesthesia exposure and expedite adjuvant therapy initiation. Real-time MRI thermography allows safe ablation of eloquently located lesions. https://thejns.org/doi/10.3171/CASE25940.