LITT in the Treatment of Adult Epilepsy

Abstract

Magnetic resonance-guided laser interstitial thermal therapy (MRg-LITT) is becoming an increasingly used and more thoroughly understood method for real-time monitored thermal lesioning of tissue. It has found a particular niche in the treatment of medically refractory focal epilepsy for which it provides a less invasive alternative to craniotomy and resection for multiple pathologies such as mesial temporal lobe sclerosis, focal cortical dysplasia, cavernous malformations, hypothalamic hamartoma, and epileptogenic tumors. Stereotactic laser brain ablation is also an alternative to craniotomy for cortical resections in non-lesional epilepsy as well as to disconnection surgery as in corpus callosotomy. Clinical investigations have focused on understanding the advantages as well as limitations of using MRg-LITT in epilepsy surgery, especially for mesial temporal sclerosis (MTS), which has been the most studied etiology. Though laser ablation for MTS shows a good safety and efficacy profile compared to open surgery, the minimally invasive nature of this technique is also an attractive and promising method both for practitioners and patients for surgical treatment of multiple etiologies of focal epilepsy.