Laser Interstitial Thermal Therapy (LITT)

Laser interstitial thermal therapy (LITT) is a minimally invasive treatment that uses precisely controlled laser energy to destroy targeted abnormal brain tissue. LITT may be an option for patients with certain brain tumors or radiation necrosis, particularly when the area to be treated is located deep within the brain or when traditional open surgery may be more difficult or carry greater risk.

LITT uses real-time MRI guidance to help your neurosurgeon precisely target the area requiring treatment. During the procedure, laser energy heats the targeted tissue to a carefully controlled temperature, causing the abnormal tissue to be destroyed while allowing your surgical team to monitor the treatment throughout the procedure.

Unlike traditional open brain surgery, LITT does not require a large incision or removal of a portion of the skull. Instead, your surgeon makes a very small opening in the skull and places a thin laser probe into the targeted area. This minimally invasive approach may allow for a shorter recovery and hospital stay compared with some traditional surgical approaches.

For patients with radiation necrosis, LITT can be used to treat the damaged tissue that develops after radiation therapy. In selected patients, treating the area of radiation necrosis may help reduce symptoms and swelling and may decrease the need for long-term steroid treatment.

Your doctor will review your imaging, medical history, previous treatments, and overall health to determine whether LITT is an appropriate treatment option for you.

Before your procedure, you will undergo detailed brain imaging, usually including an MRI, to determine whether LITT is appropriate for you. Your neurosurgical team will use your imaging to identify the area requiring treatment and plan the safest path for placement of the laser probe.

On the day of your procedure, you will receive anesthesia and will be asleep during treatment. Your surgeon will make a very small opening in the skull and carefully guide a thin laser probe into the targeted area of the brain.

The procedure is performed inside an MRI scanner. MRI guidance allows your surgical team to see the position of the laser probe and monitor the temperature of the surrounding brain tissue in real time. Your surgeon can then precisely control the amount of laser energy delivered to the treatment area.

The laser heats the targeted tissue to a temperature that causes the abnormal tissue to be destroyed. MRI temperature monitoring helps your surgeon control the size and location of the treatment area and avoid unnecessary heating of nearby healthy brain tissue.

After treatment, additional MRI images are obtained to evaluate the treated area.

The procedure typically takes several hours, although the exact length will depend on the location and size of the area being treated and your individual circumstances.

Because LITT is minimally invasive, many patients have a shorter hospital stay and recovery compared with traditional open brain surgery. Your individual recovery and length of stay will depend on your condition and your physician’s recommendations.

With any procedure, there are risks. You should talk with your doctor about the potential risks and benefits of LITT based on your individual condition and the location of the area being treated.

Potential complications may include bleeding, infection, brain swelling, headache, nausea, seizures, or temporary or permanent neurological changes. Depending on the location of the treatment area, neurological complications may include weakness, numbness, difficulty with speech or language, problems with vision, balance difficulties, confusion, or other changes in brain function.

Because LITT uses heat to destroy targeted brain tissue, the treated tissue is intentionally damaged. Swelling around the treatment area can occur during the recovery period and may temporarily worsen neurological symptoms.

The specific risks of LITT depend on the location of the lesion, the size of the treatment area, your overall health, and other factors. Your physician will discuss the potential risks, benefits, and alternatives with you before treatment.

Your treatment team will carefully evaluate you before LITT to determine whether it is an appropriate treatment for your condition.

Before treatment, your care team will review your medical history, previous treatments, and brain imaging to determine whether LITT is right for you. Your evaluation may also include a physical and neurological examination, laboratory testing, and additional imaging or testing as needed. For patients with brain tumors or radiation necrosis, your medical team will review your prior surgery, radiation therapy, chemotherapy, immunotherapy, or other treatments as appropriate.

You should provide your healthcare team with a complete list of all medications, vitamins, and supplements you take. Your physician will review your medications and let you know if any should be temporarily stopped or adjusted before your procedure.

Follow all instructions provided by your healthcare team regarding medications, eating and drinking, and preparation for anesthesia.

Because you will receive anesthesia, you will need someone to drive you home when you are discharged. Your care team may also recommend that a responsible adult stay with you during the initial part of your recovery.

Your healthcare provider will give you specific instructions before you leave the hospital. In general, you should plan to rest following your procedure and gradually return to your normal activities as directed by your physician.

Follow all medication, wound-care, and activity instructions provided by your healthcare team. Keep the small incision where the laser probe was inserted clean and dry according to your discharge instructions.

Contact your doctor’s office if you develop worsening headaches, fever, drainage or increasing redness around the incision, seizures, new or worsening weakness, difficulty speaking, confusion, vision changes, or other symptoms that concern you.

Your healthcare team will tell you when you can safely return to your usual activities, including work, exercise, driving, and other daily activities.

You may experience headache, fatigue, nausea, or soreness around the area where the laser probe was inserted following your procedure. Some patients may experience temporary neurological symptoms related to swelling or irritation around the treated area.

Recovery varies depending on the location and size of the treatment area and your overall health. Because LITT uses a very small opening rather than the larger incision required for a traditional craniotomy, recovery may be shorter than with some open surgical procedures.

If you underwent LITT for a brain tumor, your physician will schedule follow-up appointments and imaging to monitor the treated area and evaluate your response to treatment. Depending on your diagnosis and previous treatments, additional therapy may be recommended.

For patients treated for radiation necrosis, follow-up imaging and clinical evaluations will help your care team determine how the treated area is responding. Your physician may also adjust medications used to manage swelling or other symptoms as you recover.

Your physician will provide a personalized follow-up plan based on your diagnosis, treatment, and recovery.