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

Usama Salem,Ganesh Rao,Vinodh A Kumar,John E Madewell,Sujit S Prabhu,Jeffrey S Weinberg,Dhiego Chaves De Almeida Bastos,Rivka R Colen,Pascal O Zinn,Donald F Schomer

doi:10.1186/s40644-019-0250-4

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.

Highlights

Magnetic resonance imaging (MRI)-guided laser interstitial thermal therapy (LITT) is the selective ablation of a lesion or a structure using heat liberated from a laser [1]
We provide an example of a patient with brain metastases who was successfully treated at our intuition using LITT (Fig. 2)
We provide an example of a patient with radiation necrosis who was successfully treated at our intuition using LITT (Fig. 4)

Summary

Background

MRI-guided laser interstitial thermal therapy (LITT) is the selective ablation of a lesion or a structure using heat liberated from a laser [1]. We currently use LITT for treatment of selected patients with recurrent brain metastases and radiation necrosis following stereotactic radiosurgery. The study analyzed the effects of multiple factors on progression-free survival, including the extent of ablation (incomplete vs complete), dural-based status, lesion volume (> 6 cm vs < 6 cm3), systemic treatment before and after LITT, and nature of the lesion (radiation necrosis vs tumor recurrence). A Sagittal post-contrast T1-weighted imaging before LITT demonstrates a progressing enhancing lesion in the left inferior parietal lobule at a site of a brain metastasis previously treated with gamma knife radiation therapy (long arrow). D Sagittal post-contrast T1-weighted imaging 1 month after LITT demonstrates complete ablation of the lesion (dashed arrow) these patients, surgical resection of the epileptogenic focus can eliminate these seizures [62]. The ability of the nanoshell to absorb light at a specific wavelength is determined by the nanoshell size and

Catheter malposition

Findings

Conclusions