Laser Thermocoagulation (LITT)

Laser
One of the most exciting developments in the neurosurgical suite has been the incorporation of MRI capability within the operating room itself. Not only does having this capability allow surgeons to ensure that surgical success had been achieved before leaving the operating room, but it has also allowed the development of novel technologies allowing neurosurgeons to offer treatment for lesions that were not previously easy to access surgically. One of the challenges that remains in neurosurgery is the ability to treat small lesions especially if located deep in the brain. While these lesions look obvious on MRI, finding these lesions can sometimes require large access corridors through critical structures or can be hard to differentiate from the brain at the time of surgery.
LITT is the ability to use a laser to heat a lesion or area of the brain in order to kill the cells in the area. While the use of laser itself is not novel, the ability to watch the laser heating in real time in the brain in order to control the heating is now possible with the MRI in the operating room. For this procedure, patients typically still get general anesthesia although conscious sedation is possible. Under MRI guidance, the laser is introduced into the brain through a less-than-5mm scalp incision and a thin hole in the skull. Once the laser is confirmed to be in position, the laser is turned on and continuous MRI is used to watch the direction and amount of heat delivered. When the lesion has been heated entirely then the laser is turned off and removed and the scalp is closed with 2-3 staples. Most patients are able to go home the following day.
Over the past decade the indications for the use of MR-guided LITT has significantly expanded. The tool was originally designed for the treatment of primary and metastatic brain tumors failing other treatments such as radiation and surgery and this remains the major indication for use of LITT today. Within this group also fall the cases of radiation necrosis with which our center has had significant treatment success. Increasingly, however, as the technology advances, LITT has expanded its use into the area of epilepsy, particularly in patients with mesial temporal sclerosis or lesion-based seizures, the area of neurovascular such as for cavernous malformations and for benign tumors such as meningiomas. To date over a hundred cases have been treated with LITT at this facility.

Laser Thermocoagulation (LITT) Surgeons

Veronica L.S. Chiang, MD, FAANS

Professor of Neurosurgery

Jason Lee Gerrard, MD, PhD, FAANS

Assistant Professor of Neurosurgery and of Neuroscience

Murat Gunel, MD, FACS, FAHA, FAANS

Nixdorff-German Professor of Neurosurgery and Professor of Genetics and of Neuroscience

Jennifer Moliterno, MD, FAANS

Assistant Professor of Neurosurgery

Sacit Bulent Omay, MD

Assistant Professor of Neurosurgery

Joseph Massa Piepmeier, MD, FAANS

Nixdorff-German Professor of Neurosurgery