Magnetic resonance imaging-guided laser interstitial thermal therapy (LITT) is a minimally invasive treatment modality with recent increasing use to ablate brain tumors. When originally introduced in the late 1980s, the inability to precisely monitor and control the thermal ablation limited the adoption of LITT in neuro-oncology. Popularized as a means of destroying malignant hepatic and renal metastatic lesions percutaneously, its selective thermal tumor destruction and preservation of adjacent normal tissues have since been optimized for use in neuro-oncology. The progress made in real-time thermal imaging with MRI, laser probe design, and computer algorithms predictive of tissue kill has led to the resurgence of interest in LITT as a means to ablate brain tumors. Current LITT systems offer a surgical option for some inoperable brain tumors. We discuss the origins, principles, current indications, and future directions of MRI-guided LITT in neuro-oncology.

T he establishment of formal surgical training in the US originated with William Stewart Halsted when he established the training program at The Johns Hopkins Hospital in 1889. According to Halsted's philosophy, surgical training was predicated on an apprenticeship model based on several principles, among which included a close association between the resident and the professor, as well as an "indefinite tenure" of training. Recently, greater scrutiny of residency education and patient safety has led to necessary modifications in how physicians are trained.5 Duty-hour limitations established by the Accreditation Council of Graduate Medical Education (ACGME) have caused all medical specialties to reevaluate their educational curriculum, but surgical specialties may have been the most affected. Duty-hour constraints have led many neurosurgical senior residents and program directors to acknowledge that these limitations have had an adverse effect on the surgical training experience. 4,8 Pressures to improve patient safety, outcomes, and hospital efficiency are also likely to exert an effect on residency education by limiting surgical autonomy.3 The combination of these external pressures has caused training programs to reevaluate their approach to surgical education to improve the efficiency of surgical training. One strategy is to employ more hands-on training by incorporating environments into residency training that simulate the operating room experience.To comply with the newly developed mandates on surgical education, neurosurgical training programs will likely need to develop strategies for systematically assessing a trainee's surgical competency prior to graduation. The best way to develop these skills and perform such an asabbreviatioNs ACGME = Accreditation Council of Graduate Medical Education; PGY = postgraduate year. Surgical education has been forced to evolve from the principles of its initial inception, in part due to external pressures brought about through changes in modern health care. Despite these pressures that can limit the surgical training experience, training programs are being held to higher standards of education to demonstrate and document trainee competency through core competencies and milestones. One of the methods used to augment the surgical training experience and to demonstrate trainee proficiency in technical skills is through a surgical skills laboratory. The authors have established a surgical skills laboratory by acquiring equipment and funding from nondepartmental resources, through institutional and private educational grants, along with product donations from industry. A separate educational curriculum for junior- and senior-level residents was devised and incorporated into the neurosurgical residency curriculum. The initial dissection curriculum focused on cranial approaches, with spine and peripheral nerve approaches added in subsequent years. The dissections were scheduled to maximize the use of cadaveric specimens, experimenting with techniques to best preserve the tiss...

IoMRI enhances the extent of resection, particularly for nonenhancing gliomas.