MR-guided laser interstitial thermal therapy (LITT) is an emerging surgical technique that allows for the minimally invasive destruction of pathological soft tissue for a variety of central nervous system lesions ranging from brain tumors to epilepsy foci.

In the past decade, enhanced technologies, such as MRI thermometry and improved laser probe design, have opened up a new avenue of treatment for patients with lesions that would have previously been deemed too difficult to treat using conventional open craniotomy surgery. Since only a tiny hole is required, damage to cortical areas is minimized or avoided completely, even with deep lesions located near eloquent or vital areas of the brain.

See laser interstitial thermal therapy in action

In this video, Houston Methodist neurosurgeon Dr. Todd Trask and the surgical team use LITT to treat a 28-year-old patient with medically intractable epilepsy, offering an inside look at how modern operating rooms combine multiple cutting-edge technologies to revolutionize brain surgery options.

"To access this part of the brain with conventional surgery would have caused trauma and damage to the surrounding brain tissue," says Dr. Trask. "Laser interstitial thermal therapy allows us to avoid that, and as a bonus, recovery is faster, easier and the patient doesn't have a large visible scar along the scalp."

Follow along as Dr. Trask performs and narrates key tasks from the procedure, such as layering multiple imaging modalities, fixating the patient in space, placing the catheter, firing the laser and using real-time imaging to confirm results.

MRI thermometry enhances safety

"The MRI detects the temperature of the tissue and the computer algorithm displays that to us visually," Dr. Trask explains. "The yellow area indicates tissue damage that is occurring that is not yet irreversible, and the blue area shows tissue that is now dead. We can also monitor the temperature of the surrounding tissue and see that those areas are fine, the heat from the laser is not seeping out of the area where we want it."

Once the laser ablation surgery is complete, the patient stays in the hospital for one to two days and can resume normal activities in one to two weeks.

"I am happy to report the patient has been out of surgery for months now without any seizures," Dr. Trask says. "Here at Houston Methodist, we feel very fortunate to have the facilities, expertise and full suite of technologies to be able to offer laser surgery for epilepsy to our patients."