Neurosurgery
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Review Historical Article
Laser Interstitial Thermal Therapy for Mesial Temporal Lobe Epilepsy.
Approximately one-third of patients with epilepsy do not achieve adequate seizure control through medical management alone. Mesial temporal lobe epilepsy (MTLE) is one of the most common forms of medically refractory epilepsy referred for surgical management. Stereotactic laser amygdalohippocampotomy using magnetic resonance-guided laser interstitial thermal therapy (MRg-LITT) is an important emerging therapy for MTLE. ⋯ We provide a historical overview of laser interstitial thermal therapy development and the technological advancements that led to the currently available commercial systems. Current applications of MRg-LITT for MTLE, reported outcomes, and technical issues of the surgical procedure are reviewed. Although initial reports indicate that stereotactic laser amygdalohippocampotomy may be a safe and effective therapy for medically refractory MTLE, further research is required to establish its long-term effectiveness and its cost/benefit profile.
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Review
Laser Interstitial Thermal Therapy: Lighting the Way to a New Treatment Option in Neurosurgery.
LITT, laser interstitial therapyNd:YAG, neodymium-doped yttrium aluminum.
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Radiation necrosis and tumor recurrence are common sequelae after radiation therapy for brain metastasis. The differentiation of radiation necrosis and recurrent brain metastases continues to remain a difficult task despite a number of diagnostic methods. Techniques including magnetic resonance imaging, diffusion-weighted imaging, nuclear studies, and the gold standard of biopsy have all been studied for their effectiveness in accurately diagnosing the postradiation condition. ⋯ This further emphasizes the necessity to accurately diagnose the condition to start appropriate and effective treatment. Despite both pathologies being pathophysiologically distinct, controversies exist as to whether there should be a distinction made at all or if the two can be perceived as a single condition if treatment and presentation are similar enough. Furthermore, a single treatment option such as magnetic resonance-guided, laser-induced thermal therapy (MRgLITT) can be used, potentially eliminating the need to differentiate the 2 entities because it successfully treats both conditions while being minimally invasive.
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The value of maximal safe cytoreductive surgery in recurrent high-grade gliomas (HGGs) is gaining wider acceptance. However, patients may harbor recurrent tumors that may be difficult to access with open surgery. Laser interstitial thermal therapy (LITT) is emerging as a technique for treating a variety of brain pathologies, including primary and metastatic tumors, radiation necrosis, and epilepsy. ⋯ BBB, blood-brain barrierFDA, US Food and Drug AdministrationGBM, glioblastoma multiformeHGG, high-grade gliomaLITT, laser interstitial thermal therapy.
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Recurrent malignant glioma continues to be a clinical challenge, and repeat surgery is an option in only select patients. Stereotactic laser ablation, a new minimally invasive technique, can be used as an alternative to surgery. We review the current literature on laser ablation for recurrent malignant gliomas as well as discuss practical and theoretical advantages and disadvantages of this emerging technique in comparison with repeat surgery or radiation. We also discuss the potential for laser ablation to augment adjuvant therapies, namely, chemotherapy, radiation, and immunotherapy.