Neurosurgical applications of MRI guided laser interstitial thermal therapy (LITT)

Abstract

MRI-guided laser interstitial thermal therapy (LITT) is the selective ablation of a lesion or a tissue using heat emitted from a laser device. LITT is considered a less invasive technique compared to open surgery that provides a nonsurgical solution for patients who cannot tolerate surgery. Although laser ablation has been used to treat brain lesions for decades, recent advances in MRI have improved lesion targeting and enabled real-time accurate monitoring of the thermal ablation process. These advances have led to a plethora of research involving the technique, safety, and potential applications of LITT. LITT is a minimally invasive treatment modality that shows promising results and is associated with decreased morbidity. It has various applications, such as treatment of glioma, brain metastases, radiation necrosis, and epilepsy. It can provide a safer alternative treatment option for patients in whom the lesion is not accessible by surgery, who are not surgical candidates, or in whom other standard treatment options have failed. Our aim is to review the current literature on LITT and provide a descriptive review of the technique, imaging findings, and clinical applications for neurosurgery.

Microfocusing sapphire capillary needle for laser surgery and therapy: Fabrication and characterization

“…As a result, photocoagulation in these areas slows down, the further exposure can change the shape of the coagulated volume and cause overheating of the instrument by significantly raising the temperature in the adjacent tissues [33,44,50]. In addition, by increasing the tissue interstitial pressure, carbonization may force the dissemination of cancer cells into deeper areas of liver [38,40]. For the considered power range, there are no carbonization of tissue, the contact surface remains wet, which contributes to the photothermal destruction with high radial homogeneity.…”

“…Majority of instruments for laser therapy solve the problem of diffuse tissue irradiation [9,10,12,[33][34][35], because, on the one hand, it increases the treated volume of tissue, and, on the other hand, redistributes laser power and protects the instrument and the fiber from the overheating at particular points. Nevertheless, a problem of the precise irradiation of a small tissue area with a focused and collimated light beam also exists, for example, for the purposes of local ablative therapy [36,37], interstitial LTT of metastatic brain and liver tumors [38][39][40], or even optogenetics [41,42].…”

Laser thermal therapy for epilepsy surgery: current standing and future perspectives

“…LITT for epilepsy treatment MRI-guided laser ablation is a promising minimal-invasive alternative to the above-mentioned classical surgical approaches of ATL and SAH for pharmaco-resistant TLE (Figure 1) [38]. Memory deficits and particularly verbal memory deficits are feared complications after TLE surgery.…”

Surgical Management of Brain Metastases in the Perirolandic Region

“…Interstitial brachytherapy enables the accurate application of highly focused necrotizing tissue dose with a steep fall-off from the center to the periphery (9,87), which can be indicated in eloquent BM that are not amenable to resection even after previous irradiation or radiosurgery (87,88). Additionally, LITT can deliver enough thermal damage and induce coagulation to tumor while simultaneously avoiding damage to surrounding brain parenchyma ( Figure 5) (35,89,90), shortening duration of both operation and hospitalization (91,92). Lyer et al first presented a patient who underwent MRIguided LITT for BM in the motor strip and had an excellent outcome (66).…”