Epilepsy and brain tumours require surgeries with large incisions and long recovery periods. However, Laser Interstitial Thermal Therapy (LITT), a minimally invasive procedure has gained momentum in the recent decade, that offers a potential solution.
LITT is a minimally invasive procedure that uses heat to destroy abnormal brain tissue, such as tumours or areas causing epilepsy. First developed in 1983 by Stephen G Bown, subsequent animal studies and clinical trials proved the procedure’s effectiveness in treatment for intracranial neoplasms (tumours inside the skull). However, one major challenge was that doctors couldn’t measure the temperature of tissue during the procedure, which made it difficult to control how much tissue was destroyed.
Recent advances in MRI technology have contributed to LITT’s current form. The procedure could be described as follows:
Before surgery, a CT or MRI scan is done to get a detailed image of the brain.
Using computer software, the surgeon plans the best path to reach the target area, usually going down the centre of the lesion. Sometimes, multiple paths are needed for full treatment.
In the operating room, the patient is positioned to ensure that the laser probe can be placed correctly, especially since space inside the MRI machine is limited.
The laser probe is inserted using a small incision, and the surgery can be done using different tools, such as a robotic arm or stereotactic frames.
The patient is placed into an MRI scanner. The MRI provides real-time images that help guide the laser and track the temperature of the tissue during the procedure.
Once the treatment is complete, the laser is removed and the incision is closed.
The procedure is primarily used for brain tumours, particularly useful for deep-seated, difficult-to-access tumours. LITT could also be used with tumours that are resistant to radiotherapy along with patients where larger, open surgeries carry heavy risks. LITT is also commonly used to treat epilepsy, in cases where patients do not respond to medication. Multiple studies have suggested that using LITT tro treat epilepsy is marginally safer than more conventional approaches.
Moving forward, LITT may be used to supplement open surgery. For example, in certain large tumours where LITT is not feasible, open surgery may be used to reduce tumour size, followed by LITT to treat the patient.
Like most minimally invasive surgeries, one of the main advantages of LITT is the faster recovery times and less pain post-surgery. LITT also offers fewer complications and improved precision during surgery compared to more traditional open surgeries
However, LITT is still not suitable for all neurological conditions, or all tumour types, particularly large tumours. Furthermore, LITT is a costly procedure, which may not make it an option for everyone.
Ongoing research explores LITT in combination with treatments like immunotherapy and chemotherapy to enhance cancer-fighting outcomes. Additionally, improvements in MRI thermometry and robotic guidance systems aim to increase the precision of LITT, particularly in treating brain tumours and epilepsy. Researchers are also investigating the potential of LITT in other areas, such as liver and spinal tumours, broadening its scope beyond the brain. As these advancements continue, LITT could become a more widely used, minimally invasive option for various conditions.
In conclusion, Laser Interstitial Thermal Therapy is a minimally invasive procedure used to treat brain tumours and epilepsy. It offers the advantages of faster recovery times and increased precision compared to traditional open surgeries and has the scope to supplement other techniques to provide holistic patient care.
References:
[1] Patel, Bhuvic, and Albert H Kim. “Laser Interstitial Thermal Therapy.” Missouri medicine vol. 117,1 (2020): 50-55.
[2] Johns Hopkins Medicine. “Laser Interstitial Thermal Therapy.” Johns Hopkins Medicine, https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/laser-interstitial-thermal-therapy. Accessed 27 Sept. 2024.
[3] Doe, Jane, and Michael Adams. "Expanding the Applications of Laser Interstitial Thermal Therapy: From Brain to Body." Journal of Oncology Advances, vol. 45, no. 2, 2022, pp. 88-101.