Emerging indications for stereotactic laser interstitial thermal therapy in pediatric neurosurgery

Abstract

Surgical treatment of deep or difficult to access lesions represents a unique and significant challenge for pediatric neurosurgeons. The introduction of stereotactic magnetic resonance-guided laser interstitial thermal therapy (LITT) over the last decade has had a dramatic impact on the landscape of pediatric neurosurgery. LITT provides a safe and effective option for children with epilepsy from hypothalamic hamartoma that represents a groundbreaking new therapy for a condition which was historically very difficult to treat with previous neurosurgical techniques. LITT has also been used as an alternative surgical technique for mesial temporal sclerosis, focal cortical dysplasia, MR-negative epilepsy, cavernoma-related epilepsy, insular epilepsy, and corpus callosotomy among other epilepsy etiologies. In some cases, LITT has been associated with improved cognitive outcomes compared to standard techniques, as in mesial temporal lobe epilepsy. Initial experiences with LITT for neuro-oncologic processes are also promising. LITT is often attractive to patients and providers as a minimally invasive approach, but the differences in safety and clinical outcome between LITT and traditional approaches are still being studied. In this review, we examine the emerging indications and clinical evidence for LITT in pediatric neurosurgery.

The utility of diffusion tractography for speech preservation in laser ablation of the dominant insula: illustrative case

“…LITT with MR thermometry has been used for several years to treat epilepsy in children and adults, primarily for lesional epilepsy (e.g., mesial temporal sclerosis) but also for sEEG-localized seizure onset zones with MRI-negative presentations. 5,[14][15][16] Several previous cases of LITT used for insular epilepsy have been reported, both lesional and nonlesional. 2,12,13 However, our use of DTI tractography to aid insular LITT in the dominant hemisphere is the first such case reported (to our knowledge).…”

Magnetic Resonance-Guided Laser Interstitial Thermal Therapy (MR-gLiTT) in Pediatric Epilepsy Surgery: State of the Art and Presentation of Giannina Gaslini Children's Hospital (Genoa, Italy) Series

“…These classifications play a less relevant role in MR-gLiTT, which can also be planned in multiple steps for particularly voluminous lesions ( 13 ). Treatment of HH-associated epilepsy using LiTT is providing extremely encouraging results, both when evaluated in absolute terms and in comparison with other treatment options (e.g., open surgery, endoscopic, radiosurgery) ( 1 , 14 ). In a recent review, seizure control achieved by LiTT in patients with a follow-up of at least 1 year was 87% in patients with gelastic seizures and 60% in patients with other type of seizures ( 15 ).…”

“…Magnetic resonance-guided laser interstitial thermal therapy (MR-gLiTT) is a novel and very promising minimally invasive therapeutic approach in the field of neurosurgery. The two major indications for this type of neurosurgical treatment are drug-resistant focal epilepsy and brain tumors ( 1 ). LiTT uses heat to generate ablation by light absorption of tissue ( 2 ).…”

Resting-State Functional Magnetic Resonance Imaging Networks as a Quantitative Metric for Impact of Neurosurgical Interventions

“…The ability to create targeted, conformal thermal lesions in a minimally invasive manner makes LITT an attractive option for treating numerous central nervous system (CNS) lesions. LITT has been described for the treatment of epileptic foci, primary and metastatic brain tumors, and radiation necrosis, with new indications continuing to be developed (Hawasli et al, 2011(Hawasli et al, , 2014Torres-Reveron et al, 2013;Kamath et al, 2017;Bijanki et al, 2020;Hafez et al, 2020;Remick et al, 2020). For example, rs-fMRI has been used at our institution during stereotactic LITT procedures both to plan a trajectory that avoids traversing eloquent cortex and to create an ablative lesion that spares eloquent cortex (Salehi et al, 2018).…”