Visualase

Manufactured by Medtronic

Sourced in United States

Visualase is a laser-based surgical tool designed for minimally invasive procedures. It provides precise and controlled tissue ablation by utilizing a laser source to generate thermal energy. The core function of Visualase is to enable the targeted destruction of abnormal or diseased tissue while minimizing damage to surrounding healthy structures.

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Lab products found in correlation

3t mri scanner, by Philips (1 mentions) Stealthstation, by Medtronic (1 mentions) Framelink, by Medtronic (1 mentions) 3t mri scanner, by Siemens (1 mentions)

9 protocols using visualase

Laser Interstitial Thermal Therapy for Brain Tumors

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All procedures were performed in an intraoperative MRI suite with a Siemens Espree 1.5T bore (Siemens, Berlin, Germany). LITT procedures were performed by either S.P. or G.R. with either the Visualase (Medtronic, Minneapolis, USA) or Neuroblate (Monteris, Winnipeg, Canada) LITT systems. Details regarding the technique used were reported previously[14 (link)]. With the Neuroblate system, the enhancing margins of the tumor were treated to the thermal-damage threshold line corresponding with exposure to 43°C for 10 minutes which is sufficient to induce cell death. Depending up on the geometry of the lesion, either the side-fire or diffusion tip was used. With the Visualase system, the thermal damage was assessed by an expanding volume of thermal damage seen with real time MRI scanning after a high temperature limit is set at 90°C near the tip of the applicator. The low temperature limit is set at 47–50°C at the borders of the target area or near critical structures in order to avoid unintended thermal damage. All lesions were treated to a target temperature of at least 46°C throughout the volume of the lesion to ensure cell death. For larger lesions, a single probe was used and advanced or withdrawn for adequate coverage. In some cases, particularly for irregularly shaped lesions, multiple probes were used.

Beechar V.B., Prabhu S.S., Bastos D., Weinberg J.S., Stafford R.J., Fuentes D., Hess K.R, & Rao G. (2017). Volumetric Response of Progressing Post-SRS Lesions Treated with Laser Interstitial Thermal Therapy. Journal of neuro-oncology, 137(1), 57-65.

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Comparison of Thermal Therapy Modalities

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The phantom was used to assess two different thermal therapy modalities: MW and laser. Two cylindrical TMTC phantoms (volume 1 L, diameter 10 cm) were produced. Heating of the phantoms was performed using either a clinical water-cooled 1.6 mm diameter MW applicator (HS AMICA MW ablation system, Hospital Service SpA, Aprilia, Italy) with a 10 mm dielectric tip and operated at 2450 MHz, or a clinical side-firing 1.65 mm diameter laser applicator (Visualase, Medtronic, Minneapolis, MN) with a cooling catheter and 20 mm active tip. The parameters for MW and laser ablations were 60 W for 10 min and 15 W for 90 s, respectively. Figure 2 depicts the experiment set-up for both MW and laser ablation. In each phantom the applicator was advanced to the centre of the phantom, and the device operated using the above parameters.

Negussie A.H., Partanen A., Mikhail A.S., Xu S., Abi-Jaoudeh N., Maruvada S, & Wood B.J. (2016). Thermochromic tissue-mimicking phantom for optimisation of thermal tumour ablation. International journal of hyperthermia : the official journal of European Society for Hyperthermic Oncology, North American Hyperthermia Group, 32(3), 239-243.

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Stereotactic Laser Ablation for Epilepsy

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In all 16 patients, based on seizure focus localization, SLAH was performed as previously described^{49 (link)}. The neurosurgical operative technique for SLAH involves stereotactic planning of an occipital to amygdalohippocampal trajectory for MRI-thermal guided laser ablation (Visualase™, Medtronic, Dublin, Republic of Ireland) AH employing between 3 to 5 thermal ablation isocenters per patient. The goal is optimal thermal ablation of the amygdala and hippocampus, from the amygdala anteriorly to the hippocampus at least at the level of the tectum posteriorly. All patients were evaluated at a minimum of 12-months follow-up on anticonvulsant medication to determine post-operative seizure outcome defined as “seizure-free” or “not seizure-free” (Table 1). Patients experiencing “auras only” were classified as “not seizure-free”. A patient having a rare seizure due to anticonvulsant medication non-compliance followed by prolonged resumption of seizure freedom associated with anticonvulsant medication compliance was classified as “seizure-free”.

Sprissler R., Bina R., Kasoff W., Witte M.H., Bernas M., Walter C., Labiner D.M., Lau B., Hammer M.F, & Weinand M.E. (2019). Leukocyte expression profiles reveal gene sets with prognostic value for seizure-free outcome following stereotactic laser amygdalohippocampotomy. Scientific Reports, 9, 1086.

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Stereotactic Biopsy and LITT Protocol

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Patients were placed in a sitting/half-sitting position (Figure S2). The frame was attached to the Mayfield holder. After skin preparation and draping, a 5 mm skin incision and a 3.2 mm twist drill were placed in line with the planned trajectory. Three to five biopsies were taken from the target using a 2.1 mm side-cutting biopsy needle (Elekta, Sweden). Wounds were closed using staples or sutures. In case of an additional LITT procedure, a laser catheter (Visualase, Medtronic) was placed after removal of the biopsy needle, and patients were transferred to the MRI suite for real-time visualization of tumor ablation.

Krüger M.T., Terrapon A.P., Hoyningen A., Kim C.H., Lauber A, & Bozinov O. (2022). Posterior Fossa Approaches Using the Leksell Vantage Frame with a Virtual Planning Approach in a Series of 10 Patients—Feasibility, Accuracy, and Pitfalls. Brain Sciences, 12(12), 1608.

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Stereotactic Laser Amygdalo-Hippocampectomy Protocol

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A reference CT was obtained with the anesthetized, paralyzed patient in a stereotactic frame (Integra CRW) and fused with a planned trajectory derived from a preop contrasted 3-Tesla thin-cut MRI. A burrhole was drilled using a 3.2mm drill bit and then a Visualase (Medtronic; Minneapolis, MN) laser fiber was then inserted through an applicator aligned by the frame and then secured by bone anchor. Then, in the MRI suite reference images were obtained to ensure accurate placement of the laser. High temperature (90°C) safety markers were dispersed throughout the amygdala and hippocampus. Low temperature (55°C) safety markers were usually placed along the border of the midbrain and basal ganglia. We typically performed two ablations at 80 % of maximal power for the amygdala. Then retracted the laser fiber in 1 cm intervals serially ablating the head, body and tail of the hippocampus while decreasing laser power to 60 %. Care was taken to avoid ablation of the optic radiations by not ablating posterior to the tectal plate.

Jermakowicz W.J., Ivan M.E., Cajigas I., Ribot R., Jusue-Torres I., Desai M.B., Ruiz A., D’Haese P.F., Kanner A.M, & Jagid J.R. (2017). Visual Deficit From Laser Interstitial Thermal Therapy for Temporal Lobe Epilepsy: Anatomical Considerations. Operative Neurosurgery, 13(5), 627-633.

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LITT for LGG and Radiation Necrosis

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The present study is part of a single-institution retrospective case series of clinical and survival outcomes after LITT for multiple pathologies, with this study focused on LGG and RN. Informed consent was not required due to the retrospective nature of the study and low risk of patient identification. The study was approved by the institutional review board of St. Joseph’s Hospital and Medical Center in Phoenix, AZ, USA. Data were collected from the electronic medical record, and MRI was reviewed from a picture archiving and communication system (Merge, IBM). The NeuroBlate (Monteris Medical, Minnetonka, MN, USA) and Visualase (Medtronic, Minneapolis, MN, USA) laser ablation systems were used for all patients included in this study. This case series has been reported in line with the PROCESS Guideline [31 (link)].

Scherschinski L., Jubran J.H., Shaftel K.A., Furey C.G., Farhadi D.S., Benner D., Hendricks B.K, & Smith K.A. (2022). Magnetic Resonance-Guided Laser Interstitial Thermal Therapy for Management of Low-Grade Gliomas and Radiation Necrosis: A Single-Institution Case Series. Brain Sciences, 12(12), 1627.

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Laser-Assisted Ablation of Hypothalamic Hamartomas

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The SLAH technique has been previously described. 21 Following induction of general anesthesia, the patient's head was immobilized in a stereotactic frame (CRW, Integra LifeSciences Corp.). A 1-mm intraoperative CT scan was then obtained and merged with preoperative T1-weighted gadolinium contrast-enhanced MRI using StealthStation (Medtronic). A 3.2-mm occipital twist drill trephination was created. A 1.6-mm-diameter outer polycarbonate cooling catheter, containing an inner 400-µmdiameter optical fiber (Visualase, Medtronic), was implanted along the long axis of the AHC. Catheter placement accuracy was confirmed with intraoperative CT. The patient was brought to a 3T MRI scanner (Philips). After a 5-W test ablation, a series of 3-5 ellipsoid ablations were performed at 9 W along the catheter axis. Ablation was guided by MR thermography with an irreversible damage threshold of 70°C. Immediate postablation contrast-enhanced T1-weighted MRI was performed. The catheter and laser fiber were then removed, and the incision was closed.

Satzer D., Tao J.X, & Warnke P.C. (2021). Extent of parahippocampal ablation is associated with seizure freedom after laser amygdalohippocampotomy. Journal of neurosurgery, 135(6).

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Laser Ablation Protocols for Brain Metastases

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The study was conducted under protocols approved by the institutional review boards at the following institutions: University of California San Diego (UCSD); Barrow Neurological Institute (BNI); Cleveland Clinic (CC); and Case Western (CW). Patient characteristics (age, sex, primary tumor histology, tumor location), corticosteroid regimens, and surgical morbidity information were collected through chart review. For BMs treated using the NeuroBlate system (Monteris Medical), tumor volume and percent of ablation covered by the blue isotherm line (tissue heated to 43°C for ≥ 10 minutes) were calculated by the company software. Information pertaining to percent tumor ablation for lesions treated with the Visualase (Medtronic) system was not available. Tumor volumes for these lesions were calculated using 3D Slicer (www.slicer. org), ImageJ (https://imagej.nih.gov/ij/), or by estimation based on maximal diameters. Surveillance MRIs were performed every 1-2 months after SLA for all treated patients. Radiographic responses were assessed based on the Neurologic Assessment in Neuro-Oncology (NANO) criteria at the time of the last follow-up. 12

Ali M.A., Carroll K.T., Rennert R.C., Hamelin T., Chang L., Lemkuil B.P., Sharma M., Barnholtz-Sloan J.S., Myers C., Barnett G.H., Smith K., Mohammadi A.M., Sloan A.E, & Chen C.C. (2016). Stereotactic laser ablation as treatment for brain metastases that recur after stereotactic radiosurgery: a multiinstitutional experience. Neurosurgical focus, 41(4).

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Laser Ablation Using Visualase System

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All patients underwent laser ablation using the Visualase (Medtronic) system. The laser catheter was placed using stereotactic guidance via the CRW (Integra) frame in the operating room after induction of general anesthesia; target coordinates were determined using a preoperative registration MRI scan and the Framelink (Medtronic) software. After placement, real-time MR thermometry was performed using a Siemens 3-T MRI scanner, and ablation was performed using the Visualase workstation under direction of the senior author (J.G.O.). After treatment, postablation MRI sequences were obtained, the catheter was removed, and the patient was observed in the hospital.

Buckley R.T., Wang A.C., Miller J.W., Novotny E.J, & Ojemann J.G. (2016). Stereotactic laser ablation for hypothalamic and deep intraventricular lesions. Neurosurgical focus, 41(4).

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