Laser interstitial thermal therapy (LITT)

نظرة عامة

Laser interstitial thermal therapy (LITT) is a type of minimally invasive brain surgery. It uses heat from a laser to destroy a small area of brain tissue. This also is called laser ablation. Ablation means deactivating or destroying tissue using heat or other methods.

During LITT, a surgeon makes a small opening that is 2 to 4 millimeters in the skull and places a thin tube that delivers laser heat into the brain. The procedure is a form of MRI-guided laser ablation, meaning magnetic resonance imaging (MRI) is used during treatment to guide the laser and monitor temperature in real time. This helps control the area being treated and lowers the risk of damage to nearby brain tissue.

Unlike open brain surgery, LITT does not require a large incision or removal of part of the skull.

LITT is most often used to treat drug-resistant epilepsy and some brain tumors, including glioblastoma.

In people with high-grade glioma or brain metastasis, LITT may be used when a tumor is deep in the brain or not safe to remove with open surgery.

Because LITT uses a small opening instead of open brain surgery, it often has shorter hospital stays and faster recovery. It is common to go home within 24 hours of the procedure.

LITT is not right for everyone. Care teams look at the size and location of the brain lesion, overall health, and treatment goals to decide whether this procedure is a good option.

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Laser interstitial thermal therapy (LITT) is done to treat certain brain conditions when medicine alone is not enough or when open brain surgery may carry higher risk. LITT may be done as a first surgical treatment before open brain surgery is considered.

Compared with open brain surgery, LITT uses a smaller opening in the skull and usually involves a shorter hospital stay. However, in some conditions, open surgery may offer a higher chance of complete removal of the affected tissue.

Drug-resistant epilepsy

LITT is most often used for people with drug-resistant epilepsy. This is when seizures continue even after trying two or more antiseizure medicines. It is a type of laser surgery for epilepsy that targets the small area of the brain where seizures begin. When seizures start in one small area of the brain, LITT may be used to destroy that area and reduce or stop seizures.

LITT is commonly used for temporal lobe epilepsy, especially when seizures begin in deep structures such as the hippocampus. It also may be used when a small, clearly defined area of the brain is causing seizures, especially if the area is deep or hard to reach. In these cases, LITT may reduce the risk of side effects compared with more-complex surgical approaches.

Healthcare professionals sometimes use LITT to treat different brain growths that can cause epilepsy. Hypothalamic hamartoma is one of the growths that LITT can help treat.

Brain tumors

LITT also may be used to treat some brain tumors, including brain metastases, high-grade glioma and recurrent glioblastoma. It is one type of minimally invasive brain tumor surgery that uses heat instead of removing the tumor through a large opening.

LITT is often considered when a tumor is deep in the brain or close to areas that control speech or movement. In these cases, open surgery may be harder to do safely.

It also may be used when glioblastoma comes back after earlier treatment.

Radiation necrosis

LITT may be an effective alternative treatment for radiation damage in the brain rather than taking medicines that have side effects that affect the whole body.

When LITT may be considered

LITT may be considered when:

• The area that needs treatment is small and clearly defined.
• The lesion is deep in the brain.
• Open surgery may pose higher risk.
• The person wants a treatment that uses a small opening instead of open brain surgery.

Care teams review imaging, overall health and treatment goals to decide whether LITT is an appropriate option.

Benefits of LITT

Laser interstitial thermal therapy (LITT) has some advantages compared with open brain surgery:

• Shorter recovery time. Most people return to usual activities sooner than with open brain surgery because the procedure uses a small opening and avoids a large incision. This may mean less pain and a quicker recovery.
• Real-time MRI guidance. The procedure is done in an MRI machine. The MRI shows where the laser is and tracks the heat during treatment. This helps the surgeon treat the affected area and avoid nearby brain tissue.
• Short hospital stay. Most people stay in the hospital one day or less. Some people go home the same day.
• May treat deep brain areas. LITT may be an option when a lesion is deep in the brain or close to areas that control speech or movement. In these cases, open surgery may carry higher risk.
• Can reduce seizures. In people with temporal lobe epilepsy that does not improve with medicine, about 55% become seizure-free after LITT. Others may have fewer seizures.

Limitations of LITT

LITT is not the right choice for everyone:

• It works best for small areas. LITT is usually used for small, clearly defined lesions. Larger tumors or more-complex conditions may need open surgery.
• It doesn't remove the tumor. LITT destroys tissue with heat. It does not remove the tumor from the brain. In some cases, open surgery may remove more tumor tissue.
• Seizure control may be lower than with open surgery. For some types of epilepsy, open temporal lobe surgery may lead to higher seizure-free rates than LITT.
• Other treatment may still be needed. People treated for brain tumors may still need chemotherapy or radiation therapy after LITT.
• There is a risk of lasting symptoms. In studies of high-grade glioma, about 5% of people had lasting symptoms such as weakness or trouble speaking after LITT.
• You may need more than one procedure. In some cases, LITT is done in stages. This means you may have more than one procedure. This approach can help reduce the risk of swelling or side effects. Your care team reviews your imaging, overall health and treatment goals to help decide if LITT is a good option for you.

المخاطر

Laser interstitial thermal therapy (LITT) is less invasive than open brain surgery. However, as with any brain procedure, it carries risks.

Possible risks include:

• Vision changes. A known risk is losing part of the side vision. This can happen if the laser is close to vision pathways in the brain. Usually, people with vision changes have partial vision loss rather than total blindness.

• Brain swelling. Swelling in the brain can happen after LITT. The laser uses heat to destroy tissue. When tissue is heated and damaged, the body reacts. That reaction can cause inflammation and swelling.

  Swelling can cause headaches, nausea or vomiting. It also can cause temporary symptoms such as weakness, trouble speaking or confusion.

  In rare cases, swelling can increase pressure inside the skull. If that happens, medicines or other treatments may be needed to lower the pressure.

• Bleeding and infection. Bleeding in the brain is uncommon but possible. In a large study of LITT for epilepsy, bleeding occurred in about 1.5% of people. Infection can also happen, but it is rare.

• Tumor-related risks. When LITT is used to treat a brain tumor, the risks can depend on where the tumor is in the brain and how large it is.

  In studies of people with high-grade glioma, about 5% to 6% had lasting concerns, such as weakness or trouble speaking, after the procedure.

  National guidance recommends that LITT for epilepsy be done in specialized centers with careful follow-up.

  Talk to your care team about your specific risks based on the location of the brain lesion and your overall health.

كيف تستعد؟

Your care team gives you specific instructions before your LITT procedure. Preparation may be slightly different depending on whether the procedure is for epilepsy or a brain tumor.

Medical visits and planning

Before the procedure, you may have brain imaging. This is usually an MRI. These images help your care team plan the exact path for the laser and confirm the area that needs treatment.

You also may have some blood tests and a physical exam to make sure you are healthy enough for anesthesia. LITT is done under general anesthesia, which means you are asleep during the procedure.

Medicines and health conditions

Tell your care team about all medicines you take. This includes prescription drugs, medicines you can buy without a prescription and supplements. Ask your care team if you should take your usual medicines the morning of surgery.

You may need to stop certain medicines before surgery. Blood thinners are often stopped to lower the risk of bleeding.

If you are being treated for epilepsy, you may need to continue to take your seizure medicines. Your neurologist can give you clear instructions. The medicine carbamazepine (Tegretol, Carbatrol, others) can increase the risk of bleeding. If you take seizure medicines, talk to your care team about it prior to your surgery.

Let your care team know about any health conditions, such as heart problems, diabetes or sleep apnea.

Food and activity before surgery

You likely will need to not eat or drink for several hours before the procedure. This helps lower the risk of problems with anesthesia. Follow the instructions carefully.

Work, school and transportation

Plan for someone to drive you to and from the hospital. Even if you go home the same day, someone needs to drive you. You can't drive yourself.

You may need to take time off work or school. Ask your care team how much time you should plan to take off.

Support at home

Arrange for a responsible adult to stay with you for at least the first day after the procedure. You may need help with simple tasks, such as preparing meals, picking up medicines or watching for new symptoms. Your care team tells you what symptoms to watch for once you are home.

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Before

On the day of the procedure, have someone drive you to the medical facility for the LITT procedure. A member of your care team may review your medical history and check your vital signs, such as blood pressure and heart rate.

You may have an IV line placed in your arm. This allows your care team to give you fluids and medicines.

A member of the anesthesia team likely talks to you before your procedure. The team member reviews your health history and explains how anesthesia is given. LITT is usually done under general anesthesia, which means you are asleep during the procedure.

Your care team may review the treatment plan with you. Before going into the procedure room, you may need to remove jewelry, glasses or other personal items. The area of the scalp targeted for treatment may be cleaned and prepared.

Then you go to the MRI suite or operating area where the procedure takes place. Either the day of or the day before your procedure, you likely will have an MRI safety screening.

During

You are under general anesthesia during the procedure. After you are asleep, the surgeon makes a small opening in the skull. A thin laser device is guided through this opening to the exact area being treated. The path is planned ahead of time using images from your MRI.

The procedure is done in an MRI suite. Magnetic resonance imaging is used during the procedure to guide the laser and monitor temperature in real time. This allows the surgeon to see how heat spreads and adjust the treatment as needed. The goal is to treat the targeted area while protecting nearby healthy brain tissue.

Once the laser is in position, it delivers heat to the targeted tissue. The heat destroys the treated area while nearby structures are closely watched. In some cases, the laser device may be moved slightly to treat a larger area.

After the treatment is complete, a team member takes MRI scans. This is to make sure the correct area was treated and to measure how much tissue was affected by the heat.

The procedure usually takes several hours, depending on the size and location of the area being treated.

After

After the procedure, you move to a recovery area. Nurses monitor your breathing, heart rate and blood pressure as you wake up from anesthesia.

It is common to feel tired or sleepy. Some people have mild headaches or nausea. Your care team can give medicine to help with discomfort.

Your care team gives you instructions on how to care for your cut before you leave. Keep the area clean and dry and follow your care team's guidance about bathing or showering.

Most people stay in the hospital for one day or less. Some people may go home the same day.

Before you leave the hospital, your care team reviews your instructions with you. These may include:

• When you can return to your usual activities.
• When you can drive.
• Which medicines to continue.
• Symptoms that mean you should call your care team.

Swelling in the treated area can occur in the days after the procedure. Your care team may prescribe medicines, such as steroids, to reduce swelling if needed.

Follow-up visits and imaging are usually scheduled to monitor healing and assess how well the treatment worked.

النتائج

Results after LITT depend on the condition being treated.

Epilepsy

In people with temporal lobe epilepsy that does not improve with medicine, about 50% become seizure-free after LITT. Others may still have seizures. But some have fewer or milder seizures after the procedure.

Some people may still need antiseizure medicines after the procedure. Your neurologist can help decide whether medicines can be reduced over time.

Brain tumors

For high-grade glioma, studies show that people live about 11 to 12 months on average after LITT. These results are from selected groups, often people with smaller tumors that could mostly be treated with the laser.

If glioblastoma comes back after earlier treatment, LITT may help shrink the tumor and ease symptoms.

Metastasis

If a metastatic brain tumor keeps growing after radiation, LITT may be an option. It can help stop or slow growth in that specific area.

Long-term outlook

Results vary from person to person. Factors such as the size and location of the brain lesion, overall health, and other treatments can affect how your body responds to treatment.

Your care team can explain what results are most likely in your specific situation.

What happens next

After you go home, your care team continues to monitor your progress.

You have follow-up appointments to check how you are healing and to review your symptoms. Follow-up brain imaging, usually MRI, is often done to see how the treated area looks over time.

If you had LITT for epilepsy, your neurologist tracks your seizures. Some people become seizure-free. Others may still have seizures but less often. You may continue taking seizure medicine, and changes to medicine are made carefully over time.

If you had LITT for a brain tumor, your care team monitors the tumor for changes. More treatment, such as chemotherapy or radiation, may still be needed depending on your diagnosis.

Every person's situation is different. Your care team explains your follow-up plan and what to expect in the months ahead.